Guide To The Assessment of The Degree of Permanent Impairment The Guide Edition 2.1 of The Guide PDF, 1.84 MB

GUIDE TO THE
ASSESSMENT
OF THE
DEGREE OF
PERMANENT
IMPAIRMENT
Edition 2.1
I
ACKNOWLEDGEMENTS
Comcare gratefully acknowledges the valuable contribution to

the second edition of the Guide and to this Guide by:
> Dr Dwight Dowda
> Mr John Trungove
> Sparke Helmore, solicitors
> The Australian Government Solicitor
> All the medical specialists and associations who have
provided input and assistance in the compiling of this
document over a number of years.
II
INTRODUCTION TO EDITION 2.1 OF THE GUIDE
ACKNOWLEDGEMENTS I
1. AUTHORITY VIII
2. STRUCTURE OF THIS GUIDE IX
3. APPLICATION OF THIS GUIDE X
4. WHOLE PERSON IMPAIRMENT (WPI) XI
5. ENTITLEMENTS UNDER THE SRC ACT XII
6. NON-ECONOMIC LOSS XII
7. COMPENSATION PAYABLE XIII
8. INTERIM AND FINAL ASSESSMENTS XIII
9. INCREASE IN DEGREE OF WHOLE PERSON IMPAIRMENT XIV
PART 1—CONTENTS 2
LIST OF TABLES AND FIGURES 4
LIST OF REFERENCES 8
PRINCIPLES OF ASSESSMENT 9
1. Impairment and non-economic loss 10
2. Employability and incapacity 10
3. Permanent impairment 10
4. Pre-existing conditions and aggravation 11
5. The impairment tables 11
6. Malignancies and conditions resulting in major systemic failure 11
7. Percentages of impairment 12
8. Comparing assessments under alternative tables 12
9. Combined values 12
10. Calculating the assessment 13
11. Ordering of additional investigations 13
12. Exceptions to use of Part 1 of this guide 13
GLOSSARY 14
III
DIVISION 1—ASSESSMENT OF THE DEGREE OF AN EMPLOYEE’S PERMANENT IMPAIRMENT
RESULTING FROM AN INJURY 15
1.0 Introduction 17
1.1 Coronary artery disease 18
1.2 Hypertension 22
1.3 Arrhythmias 24
1.4 Peripheral vascular disease of the lower extremities 25
1.5 Peripheral vascular disease of the upper extremities 26
1.6 Raynaud’s disease 27
2.0 Introduction 29
2.1 Assessing impairment OF respiratory function 29
2.2 Asthma and other hyper-reactive airways diseases 31
2.3 Lung cancer and mesothelioma 34
2.4 Breathing disorders associated with sleep 34
3.0 Introduction 38
3.1 Thyroid and parathyroid glands 38
3.2 Adrenal cortex and medulla 39
3.3 Pancreas (diabetes mellitus) 40
3.4 Gonads and mammary glands 42
4.0 Introduction 44
4.1 Skin disorders 44
4.2 Facial disfigurement 47
4.3 Bodily disfigurement 48
5.0 Introduction 50
5.1 Psychiatric conditions 51
6.0 Introduction 55
6.1 Central visual acuity 58
6.2 Determining loss of monocular visual fields 61
6.3 Abnormal ocular motility and binocular diplopia 62
6.4 Other ocular abnormalities 63
6.5 Other conditions INVOLVING permanent deformities causing up to 10% impairment of the whole person 63
IV
6.6 Calculation of visual system impairment for both eyes 63
7.0 Introduction 68
7.1 Hearing loss 68
7.2 Tinnitus 68
7.3 Olfaction and taste 69
7.4 Speech 69
7.5 Air passage defects 70
7.6 Nasal passage defects 72
7.7 Chewing and swallowing 72
8.0 Introduction 74
8.1 Upper digestive tract—oesophagus, stomach, duodenum, small intestine and pancreas 76
8.2 Lower gastrointestinal tract—colon and rectum 78
8.3 Lower gastrointestinal tract—anus 81
8.4 Surgically created stomas 82
8.5 Liver—chronic hepatitis and parenchymal liver disease 83
8.6 Biliary tract 85
8.7 Hernias of the abdominal wall 86
9.0 Introduction 88
Part I—Introduction 91
9.1 Feet and toes 92
9.2 Ankles 95
9.3 Knees 97
9.4 Hips 99
9.5 Lower extremity amputations 101
9.6 Spinal nerve root impairments and peripheral nerve injuries affecting the lower extremities 103
9.7 Lower extremity function 106
Part II—Introduction 110
9.8 Hands and fingers 111
9.9 Wrists 121
9.10 Elbows 124
9.11 Shoulders 127
9.12 Upper extremity amputations 133
V
9.13 Neurological impairments affecting the upper extremities 134
9.14 Upper extremity function 145
Part III—Introduction 148
Part III—Definitions of clinical findings for diagnosis-related estimates in assessing spinal impairment 149
Part III—Multi-level fractures involving the spinal canal 151
9.15 Cervical spine—diagnosis-related estimates 152
9.16 Thoracic spine—diagnosis-related estimates 154
9.17 Lumbar spine—diagnosis-related estimates 156
9.18 Fractures of the pelvis 158
10.0 Introduction 160
10.1 The Upper Urinary Tract 160
10.2 Urinary diversion 162
10.3 Lower urinary tract 162
11.1 Male reproductive system 165
11.2 Female reproductive system 169
12.1 Disturbances of levels of consciousness and awareness 178
12.2 Impairment of memory, learning, abstract reasoning and problem solving ability 180
12.3 Communication impairments—dysphasia and aphasia 183
12.4 Emotional or behavioural impairments 184
12.5 Cranial nerves 186
12.6 Neurological impairment of the respiratory system 192
12.7 Neurological impairment of the urinary system 192
12.8 Neurological impairment of the anorectal system 193
12.9 Neurological impairment affecting sexual function 193
13.1 Anaemia 195
13.2 Leukocyte abnormalities or disease 195
13.3 Haemorrhagic disorders and platelet disorders 198
13.4 Thrombotic disorders 198
VI
DIVISION 2—GUIDE TO THE ASSESSMENT OF NON-ECONOMIC LOSS 200
Introduction 200
B1. Pain 201
B2. Suffering 202
B3. Loss of amenities 203
B4. Other loss 205
B5. Loss of expectation of life 205
B6. Calculation of non-economic loss 206
DIVISION 3—CALCULATION OF TOTAL ENTITLEMENT UNDER SECTION 24 AND SECTION 27 208
APPENDIX 1—COMBINED VALUES CHART 209
Combined values chart 209
PART 2 214
CONTENTS 214
1. Impairment and non-economic loss 218
2. Employability and incapacity 218
3. Permanent 218
4. The impairment tables 219
5. Gradations of impairment 219
6. Combined impairments 219
7. Double assessment 219
8. Fingers and toes 220
9. Inapplicability of Part 2 of this guide 220
10. Interim assessments 220
11. Application of Part 2 of the guide 220
12. Likelihood of reduction in degree of impairment 221
13. Aggravation 221
VII
GLOSSARY 221
DIVISION 1—IMPAIRMENT 223
1. Cardio-vascular system 223
2. Respiratory system 227
3. Endocrine system 229
4. Skin disorders 230
5. Psychiatric conditions 233
6. Visual system 235
7. Ear, nose and throat disorders 236
8. Digestive system 238
9. Musculo-skeletal system 243
10. Urinary system 250
11. Reproductive system 252
12. Neurological function 255
13. Miscellaneous 261
PART 2 263
APPENDIX 1 263
14. Combined values chart 263
PART 2 267
DIVISION 2—NON-ECONOMIC LOSS 267
Introduction 267
Mobility 268
Social relationships 269
Recreation and leisure activities 269
SCHEDULE OF AMENDMENTS IN EDITION 2.1 OF THE GUIDE 274
Errata from Comcare guide edition 2.0 274
Broadhurst tables 301
INDEX 306
VIII
1. AUTHORITY
Division 4 of Part II (sections 24 to 28) of the Commonwealth’s Authority for this document rests therefore in subsections 28(1),
Safety, Rehabilitation and Compensation Act 1988 (the SRC Act) 28(2) and 28(3) of the SRC Act, which provide that:
provides for payment of lump sum compensation for permanent
(1) Comcare may, from time to time, prepare a written
impairment and non-economic loss resulting from a work
document, to be called the ‘Guide to the Assessment of the
related injury.
Degree of Permanent Impairment’, setting out:
The amount of compensation payable (if any) is to be assessed (a) criteria by reference to which the degree of the
by reference to the degree of permanent impairment and the permanent impairment of an employee resulting from
degree of non-economic loss determined by Comcare under the an injury shall be determined
provisions of the approved guide: (b) criteria by reference to which the degree of non-
economic loss suffered by an employee as a result of
‘approved guide’ is defined by section 4 of the SRC Act as
an injury or impairment shall be determined; and
meaning:
(c) methods by which the degree of permanent
(a) the document, prepared by Comcare in accordance with
impairment and the degree of non economic loss, as
section 28 under the title ‘Guide to the Assessment of the
determined under those criteria, shall be expressed as
Degree of Permanent Impairment’, that has been approved
a percentage.
by the Minister and is for the time being in force; and
(2) Comcare may, from time to time, by instrument in writing,
(b) if an instrument varying the document has been approved
vary or revoke the approved Guide.
by the Minister—that document as so varied.
(3) A document prepared by Comcare under subsection (1),
and an instrument under subsection (2), have no force or
effect unless and until approved by the Minister.
This document is the new Guide to the Assessment of the Degree

of Permanent Impairment. It may be referred to as ‘this guide’
or ‘Edition 2.1 of the guide’. This guide is binding on Comcare,
licensed authorities and corporations, and the Administrative
Appeals Tribunal (subsection 29(4) of the SRC Act).
IX
2. STRUCTURE OF THIS GUIDE
This guide is divided into two parts: PART 1 OF THIS GUIDE HAS THREE DIVISIONS:
DIVISION 1—Division 1 is used to assess the degree of an

PART 1—CLAIMS FOR PERMANENT IMPAIRMENT OTHER THAN
employee’s permanent impairment resulting from an injury.
DEFENCE-RELATED CLAIMS
This part deals with the assessment of claims other than
employee’s non-economic loss resulting from impairment.
defence-related claims as defined in Part XI of the SRC Act. That
is, claims made under the SRC Act by employees who are not DIVISION 3—Division 3 is used to calculate the total entitlement
members of the Australian Defence Force. based on the assessments completed in Divisions 1 and 2.
The Principles of Assessment and Glossary in Part 1 of this

PART 2—DEFENCE-RELATED CLAIMS FOR PERMANENT
guide contain information relevant to the interpretation and
IMPAIRMENT
application of Part 1, Divisions 1 and 2.
This part deals with the assessment of defence-related claims
as defined in Part XI of the SRC Act. That is, claims made under PART 2 OF THIS GUIDE HAS TWO DIVISIONS:
the SRC Act by members of the Australian Defence Force in
relation to injuries which occurred during defence service before
employee’s permanent impairment resulting from an injury.
1 July 2004.
The responsibility for development of any guide that applies to
employee’s non-economic loss resulting from impairment.
members of the Australian Defence Force in respect of injuries
incurred after the commencement of the Military Rehabilitation The Principles of Assessment and Glossary in Part 2 of this
and Compensation Act 2004 (MRC Act) will fall to the Military guide contain information relevant to the interpretation and
Rehabilitation and Compensation Commission (MRCC). application of Part 2, Divisions 1 and 2.
X
3. APPLICATION OF THIS GUIDE
The Guide to the Assessment of the Degree of Impairment Part 2 of this Guide applies to defence-related claims for
prepared by the Commission for the Safety, Rehabilitation and permanent impairment under sections 24, 25 or 27 of
Compensation of Commonwealth Employees under section the SRC Act received by the relevant authority on and from
28(1) of the Commonwealth Employees’ Rehabilitation and 1 December 2011 for injuries related to defence service
Compensation Act 1988 and approved by the Minister of State for rendered before 1 July 2004.
Industrial Relations by notice in writing dated 27 July 1989 is
Where a request by an employee pursuant to subsection 25(1)
referred to as the ‘first edition of the guide’.
of the SRC Act (in respect of interim payment of permanent
The first edition of the guide was revoked and the second edition impairment compensation) is received by the relevant authority
of the guide applied in relation to permanent impairment claims on or after 1 December 2011, but relates to a claim under
made under sections 24, 25 or 27 of the SRC Act on and from section 24 of the SRC Act that was received by the relevant
1 March 2006. Claims under those sections received on or authority on or before 28 February 2006, that request must be
before 28 February 2006 continue to be determined under the determined under the provisions of the first edition of the guide.
provisions of the first edition of the guide.
Where a request by an employee pursuant to subsection 25(1)
The second edition of the guide is revoked on and from 1 of the SRC Act (in respect of interim payment of permanent
December 2011 and edition 2.1 of the guide applies from impairment compensation) is received by the relevant authority
that date. This edition varies the second edition by addressing on or after 1 December 2011, but relates to a claim under
medical ambiguities identified by medical practitioners using section 24 of the SRC Act that was received by the relevant
the second edition of the guide, addressing various errata and authority on or after 1 March 2006 but before 1 December
providing a 10% impairment rating for all tables within the 2011, that request must be determined under the provisions of
guide. Edition 2.1 of the Guide does not change the structure the second edition of the guide.
of the second edition of the guide or the composition of benefits
Where a claim for compensation pursuant to subsections
payable.
25(4) or 25(5) of the SRC Act (in respect of a subsequent
Except as provided below, Part 1 of Edition 2.1 of the guide increase in the degree of permanent impairment) is received by
applies to permanent impairment claims under sections 24, 25 the relevant authority on or after 1 December 2011, that claim
or 27 of the SRC Act received by the relevant authority on and must be determined under the provisions of this edition of the
from 1 December 2011. guide, notwithstanding that the initial claim for compensation
for permanent impairment may have been determined under the
provisions of the previous editions of this guide.
XI
4. WHOLE PERSON
IMPAIRMENT (WPI)
However, where the initial claim for compensation for permanent Prior to 1988, the Compensation (Commonwealth Government
impairment was determined under the provisions of the first or Employees) Act 1971 (repealed with the coming into effect of the
second edition of the guide, in determining whether or not there SRC Act) provided for the payment of lump sum compensation
has been any subsequent increase in the degree of permanent where an employee suffered the loss of, or loss of efficient use
impairment under this edition of the guide, the degree of of, a part of the body or faculty, as specified in a table of maims.
permanent impairment or the degree on non-economic loss The range of conditions compensated was exclusive and did not
shall not be less than the degree of permanent impairment reflect the broad range of work-related injuries and diseases.
or degree of non-economic loss that was determined under
This guide, like the previous editions, is, for the purposes of
the provisions of first or second edition of the guide unless
expressing the degree of impairment as a percentage, based on
that determination would not have been made but for a false
the concept of ‘whole person impairment’. Subsection 24(5)
statement or misrepresentation of a person.
of the SRC Act provides for the determination of the degree of
In this guide, ‘relevant authority’ and ‘defence-related claims’ permanent impairment of the employee resulting from an injury,
have the same meaning as defined in section 4 and Part XI of that is, the employee as a whole person. The whole person
the SRC Act. impairment concept, therefore, provides for compensation for
the permanent impairment of any body part, system or function
to the extent to which it permanently impairs the employee as a
whole person.
Whole person impairment is assessed under Division 1 of Parts

1 and 2 of this guide.
XII
5. ENTITLEMENTS UNDER THE 6. NON-ECONOMIC LOSS
SRC ACT
Where the degree of permanent impairment of the employee Subsection 27(1) of the SRC Act provides that where there
(other than a hearing loss) determined under subsection 24(5) is liability to pay compensation in respect of a permanent
of the SRC Act is less than 10 per cent, paragraph 24(7)(b) of impairment, additional compensation for non-economic loss is
the SRC Act provides that compensation is not payable to the payable in accordance with section 27.
employee under section 24 of that Act.
Non-economic loss is assessed under Division 2 of Parts 1
Subsection 24(8) of the SRC Act excludes the operation of and 2 of this guide.
subsection 24(7) in relation to impairment resulting from the
loss, or the loss of the use, of a finger or toe, or the loss of the
sense of taste or smell.
For injuries suffered by employees after 1 October 2001,

subsection 24(7A) of the SRC Act provides that, if the injury
results in a permanent impairment that is a hearing loss, the
10% threshold does not apply. In those cases, subsection
24(7A) provides that there is no compensation payable if the
permanent impairment that is binaural hearing loss is less
than 5%.
XIII
7. COMPENSATION PAYABLE 8. INTERIM AND FINAL
ASSESSMENTS
The maximum level of payment is prescribed in the legislation On the written request of the employee under subsection 25(1)
and indexed annually on 1 July in accordance with the of the SRC Act, an interim determination must be made of the
Consumer Price Index. Compensation is calculated at the rate degree of permanent impairment suffered and an assessment
applicable at the time of the assessment (In Part 1 of this guide, made of an amount of compensation payable to the employee,
see Division 3 for calculation of total entitlement). where:
> a determination has been made that an employee has
suffered a permanent impairment as a result of an injury
> the degree of that impairment is equal to or more than 10%
> a final determination of the degree of permanent impairment
has not been made.
When a final determination of the degree of permanent

impairment is made, there is payable to the employee, under
subsection 25(3) of the SRC Act, an amount equal to the
difference, if any, between the final determination and the interim
assessment.
XIV
9. INCREASE IN DEGREE
OF WHOLE PERSON
IMPAIRMENT
Where a final assessment of the degree of permanent

impairment has been made and the level of whole person
permanent impairment subsequently increases by 10%
or more in respect of the same injury, the employee may
request, pursuant to subsection 25(4) of the SRC Act, another
assessment for compensation for permanent impairment and
non-economic loss. Additional compensation is payable for the
increased level of impairment only.
For injuries suffered by employees after 1 October 2001,

pursuant to subsection 25(5) of the SRC Act, if the injury
results in a permanent impairment that is a hearing loss, there
may be a further amount of compensation payable if there is a
subsequent increase in the binaural hearing loss of 5% or more.
See section 3 (Application of this guide) as to assessments of

the degree of permanent impairment made under the previous
editions of the guide.
1
PART 1
CLAIMS FOR PERMANENT

IMPAIRMENT OTHER THAN
DEFENCE-RELATED CLAIMS
2
PART 1
CONTENTS

GLOSSARY 14
DIVISION 1—ASSESSMENT OF THE DEGREE OF AN EMPLOYEE’S PERMANENT IMPAIRMENT
RESULTING FROM AN INJURY 15
Chapter 1—the cardiovascular system 16
Chapter 2—the respiratory system 28
Chapter 3—the endocrine system 37
Chapter 4—disfigurement and skin disorders 43
Chapter 5—psychiatric conditions 49
Chapter 6—the visual system 54
Chapter 7—ear, nose and throat disorders 67
Chapter 8—the digestive system 73
Chapter 9—the musculoskeletal system 87
Chapter 10—the urinary system 159
Chapter 11—the reproductive system 164
Chapter 12—the neurological system 174
Chapter 13—the haematopoietic system 194

3
DIVISION 2—GUIDE TO THE ASSESSMENT OF NON-ECONOMIC LOSS 200
DIVISION 3—CALCULATION OF TOTAL ENTITLEMENT UNDER SECTION 24 AND SECTION 27 208
APPENDIX 1—COMBINED VALUES CHART 209
4
PART 1
LIST OF TABLES AND FIGURES
DIVISION 1—ASSESSMENT OF DEGREE AND EMPLOYEE’S PERMANENT IMPAIRMENT RESULTING FROM INJURY
CHAPTER 1—THE CARDIOVASCULAR SYSTEM CHAPTER 3—THE ENDOCRINE SYSTEM

Figure 1-A: Activities of daily living 17 Table 3.1: Thyroid and parathyroid glands 38
Figure 1-B: Symptomatic level of activity in METS Table 3.2: Adrenal cortex and medulla 39
according to age and gender 19 Table 3.3: Pancreas (diabetes mellitus) 41
Table 1.1: Coronary artery disease 20 Table 3.4: Gonads and mammary glands 42
Table 1.2.1: Diastolic hypertension 22
CHAPTER 4—DISFIGUREMENT AND SKIN DISORDERS
Table 1.2.2: Systolic hypertension 23
Table 4.1: Skin disorders 45
Figure 1-C: Definitions of functional class 24
Figure 4-A: Activities of daily living—See Column 4
Table 1.3: Arrhythmias 24
in Table 4.1 46
Table 1.4: Peripheral vascular disease of the lower
Table 4.2: Facial disfigurement 47
extremities 25
Table 4.3: Bodily disfigurement 48
Table 1.5 Peripheral vascular disease of the upper
extremities 26
CHAPTER 5—PSYCHIATRIC CONDITIONS
Figure 1-C: Definitions of functional class 27
Figure 5-A: Activities of daily living 50
Table 1.6: Raynaud’s disease 27
Table 5.1: Psychiatric conditions 51
CHAPTER 2—THE RESPIRATORY SYSTEM
CHAPTER 6—THE VISUAL SYSTEM
Table 2.1: Conversion of respiratory function values
Figure 6-A: Steps for calculating impairment of the
to impairment 31
visual system 56
Figure 2-A: Calculating asthma impairment score 33
Table 6.1: Conversion of the visual system to whole
Table 2.2: WPI derived from asthma impairment person impairment rating 57
score 34
Figure 6-B: Revised LogMar equivalent for different
Figure 2-B: Calculating obstructive sleep apnoea reading cards 59
score 35
Figure 6-C: Percentage loss of central vision in one eye 60
Table 2.4: WPI derived from obstructive sleep
Figure 6-D: Normal extent of the visual field 61
apnoea score 36
Figure 6-E: Percentage loss of ocular motility of
one eye in diplopia fields 62
Figure 6-F: Calculation of Visual System Impairment
for Both Eyes 64
5
PART 1
LIST OF TABLES AND FIGURES (continued)
CHAPTER 7—EAR, NOSE AND THROAT DISORDERS CHAPTER 9—THE MUSCULOSKELETAL SYSTEM
Table 7.2: Tinnitus 68 Figure 9-A: Activities of daily living 88
Table 7.3: Olfaction and taste 69 Figure 9-B: Tables of normal ranges of motion of joints 89
Table 7.4: Speech 70 Table 9.1: Feet and toes 93
Table 7.5: Air passage defects 71 Table 9.2: Ankles 95
Table 7.6: Nasal passage defects 72 Table 9.3: Knees 97
Table 7.7: Chewing and swallowing 72 Table 9.4: Hips 99
Table 9.5: Lower extremity amputations 101
CHAPTER 8—THE DIGESTIVE SYSTEM
Table 9.6.1: Spinal nerve root impairment affecting
the lower extremity 104
Figure 8-B: Body Mass Index criteria 75
Table 9.6.2a: Sensory impairment due to peripheral nerve
Table 8.1: Upper digestive tract—oesophagus, injuries affecting the lower extremities 105
stomach, duodenum, small intestine
Table 9.6.2b: Motor impairment due to peripheral nerve
and pancreas 76
injuries affecting the lower extremities 106
Table 8.2: Lower gastrointestinal tract—colon
Table 9.7: Lower extremity function 108
and rectum 78
Table 9.8.1a: Abnormal motion/ankylosis of the thumb
Table 8.3: Lower gastrointestinal tract—anus 81
—IP and MP joints 112
Table 8.4: Surgically created stomas 82
Table 9.8.1b: Radial abduction/adduction/opposition
Table 8.5: Chronic hepatitis and parenchymal of the thumb—abnormal motion/ankylosis 113
liver disease 83
Table 9.8.1c: Abnormal motion/ankylosis of the
Table 8.6: Biliary tract 85 fingers—index and middle fingers 115
Table 8.7: Hernias of the abdominal wall 86 Table 9.8.1d: Abnormal motion/ankylosis of the
fingers—ring and little fingers 116
Table 9.8.2a: Sensory losses in the thumb 119
Table 9.8.2b: Sensory losses in the index and
middle fingers 119
Table 9.8.2c: Sensory losses in the little finger 120
Table 9.8.2d: Sensory losses in the ring finger 120
6
PART 1
Table 9.9.1a: Wrist flexion/extension 122 CHAPTER 10—THE URINARY SYSTEM

Table 9.9.1b: Radial and ulnar deviation of wrist joint 123 Table 10.1: The upper urinary tract 161
Table 9.10.1a: Elbow flexion/extension 125 Table 10.2: Urinary diversion 162
Table 9.10.1b: Pronation and supination of forearm 126 Table 10.3: Lower urinary tract 163
Table 9.11.1a: Shoulder flexion/extension 128
CHAPTER 11—THE REPRODUCTIVE SYSTEM
Table 9.11.1b: Shoulder—internal/external rotation 130
Table 11.1.1: Male reproductive organs—penis 166
Table 9.11.1c: Abduction/adduction of shoulder 131
Table 11.1.2: Male reproductive organs—scrotum 167
Table 9.12.1: Upper extremity amputations 133
Table 11.1.3: Male reproductive organs—testes,
Table 9.12.2: Amputation of digits 134
epididymes and spermatic cords 168
Figure 9-D: Grading system 135
Table 11.1.4: Male reproductive organs—prostate and
Table 9.13.1: Cervical nerve root impairment 137 seminal vesicles 169
Table 9.13.2a: Specific nerve lesions affecting the upper Table 11.2.1: Female reproductive organs—vulva
extremities—sensory impairment 140 and vagina 170
Table 9.13.2b: Specific nerve lesions affecting the upper Table 11.2.2: Female reproductive organs—cervix
extremities—motor impairment 141 and uterus 171
Figure 9-E: Objective diagnostic criteria for CRPS Table 11.2.3: Female reproductive organs—fallopian
(RSD and causalgia) 143 tubes and ovaries 172
Figure 9-F: Impairment grading for CRPS 143
CHAPTER 12—THE NEUROLOGICAL SYSTEM
Table 9.14: Upper extremity function 146
Table 9.15: Cervical spine—diagnosis-related
estimates 152 Table 12.1.1: Permanent disturbances of levels of
consciousness and awareness 178
Table 9.16: Thoracic spine—diagnosis-related
estimates 154 Table 12.1.2: Epilepsy, seizures and convulsive
disorders 178
Table 9.17: Lumbar spine—diagnosis-related
estimates 156 Table 12.1.3: Sleep and arousal disorders 179
Table 9.18: Fractures of the pelvis 158 Table 12.2: Impairment of memory, learning, abstract
reasoning and problem solving ability 180
Figure 12-B: Clinical dementia rating (CDR) 181
7
PART 1
Table 12.3: Criteria for rating impairment due to DIVISION 2—GUIDE TO THE ASSESSMENT OF NON-ECONOMIC
aphasia or dysphasia 184 LOSS
Table 12.4: Emotional or behavioural impairments 185 Table B1: Pain 201
Table 12.5.1: The offactory nerve (I) 186 Table B2: Suffering 202
Table 12.5.3: The trigeminal nerve (V) 187 Table B3.1: Mobility 203
Table 12.5.4: The facial nerve (VII) 188 Table B3.2: Social relationships 204
Figure 12-C: % WPI modifiers for episodic conditions 190 Table B3.3: Recreation and leisure activities 204
Table 12.5.6: The glossopharyngeal, vagus, spinal Table B4: Other loss 205
accessory and hypoglossal nerves Table B5: Loss of expectation of life 205
(IX, X, XI and XII) 191
Table B6: Worksheet—calculation of non-economic
Table 12.6: Neurological impairment of the loss 206
respiratory system 192
Table 12.7: Neurological impairment of the DIVISION 3—FINAL CALCULATION OF ENTITLEMENTS UNDER
urinary system 192 SECTION 24 AND SECTION 25
Table 12.8: Neurological impairment of the C1: Worksheet—calculation of total
anorectal system 193 entitlement 208
Table 12.9: Neurological impairment affecting
APPENDICES
sexual function 193
Appendix 1: Combined Values Chart 210
CHAPTER 13—THE HAEMATOPOIETIC SYSTEM
Table 13.1: Anaemia 195
Table 13.2: Leukocyte abnormalities or disease 197
Table 13.3: Haemorrhagic disorders and platelet
disorders 198
Table 13.4: Thrombotic disorders 199
8
PART 1
LIST OF REFERENCES
Abramson MJ et al, 1996, Aust NZ J Med, 26, 697-701. Johns MW, 1991, ‘A new method for measuring daytime
sleepiness: the Epworth sleepiness scale’, Sleep, 14, 540-5.
American Academy of Sleep Medicine, 1999, ‘Sleep related
breathing disorders in adults: Recommendations for syndrome Morris JC, 1993, ‘The Clinical Dementia Rating (CDR): current
definition and measurement techniques in clinical research’, version and scoring rules’, Neurology, 43(11), 2412-2414.
1999, Sleep, 22, 667-689.
National Asthma Council, 2002, Asthma Management Handbook
American Medical Association, 1995, Guides to the Evaluation of 2002, 5th edition, Melbourne: National Asthma Council of
Permanent Impairment, 4th edition, Chicago: American Medical Australia.
Association.
American Medical Association, 2001, Guides to the Evaluation of

Permanent Impairment, 5th edition, Chicago: American Medical
Association.
American Thoracic Society Ad Hoc Committee on Impairment/

Disability Criteria, 1986, ‘Evaluation of impairment/disability
secondary to respiratory disorders’, Am Rev Respir Dis, 133,
1205-09
American Thoracic Society, 1993, ‘Guidelines for the evaluation

of impairment/disability in patients with asthma’, Am Rev Respir
Dis, 147, 1056-61.
Cummings J, Mega M, Gary K, Rosenberg-Thompson S, Carusi

D, Gornbein J, ‘The neuropsychiatric inventory: comprehensive
assessment of psychopathology in dementia’, Neurology, 1994,
44, 2308-2314.
Ensalada LH, ‘Complex regional pain syndrome’, in Brigham

CR, ed, The Guides Casebook, Chicago, Ill: American Medical
Association, 1999, 14.
9
PART 1
PRINCIPLES OF ASSESSMENT
1. IMPAIRMENT AND NON-ECONOMIC LOSS 10

2. EMPLOYABILITY AND INCAPACITY 10
3. PERMANENT IMPAIRMENT 10
4. PRE-EXISTING CONDITIONS AND AGGRAVATION 11
5. THE IMPAIRMENT TABLES 11
6. MALIGNANCIES AND CONDITIONS RESULTING IN MAJOR SYSTEMIC FAILURE 11
7. PERCENTAGES OF IMPAIRMENT 12
8. COMPARING ASSESSMENTS UNDER ALTERNATIVE TABLES 12
9. COMBINED VALUES 12
10. CALCULATING THE ASSESSMENT 13
11. ORDERING OF ADDITIONAL INVESTIGATIONS 13
12. EXCEPTIONS TO USE OF PART 1 OF THIS GUIDE 13
10
1. IMPAIRMENT AND NON-ECONOMIC LOSS 2. EMPLOYABILITY AND INCAPACITY
Under subsection 4(1) of the SRC Act, impairment means The concepts of ‘employability’ and ‘incapacity’ are not the
‘the loss, the loss of the use, or the damage or malfunction, tests for the assessment of impairment and non-economic
of any part of the body or of any bodily system or function or loss. Incapacity is influenced by factors other than the degree of
part of such system or function’. It relates to the health status impairment and is compensated by weekly payments which are
of an individual and includes anatomical loss, anatomical separate and independent to permanent impairment entitlements.
abnormality, physiological abnormality, and psychological
abnormality. The degree of impairment is assessed by reference 3. PERMANENT IMPAIRMENT
to the impact of that loss by reference to the functional capacities
of a normal healthy person. Compensation is only payable for impairments which are
permanent. Under subsection 4(1) of the SRC Act ‘permanent’
Non-economic loss is assessed in accordance with means ‘likely to continue indefinitely’. Subsection 24(2) of the
Part 1, Division 2 (see page 200) of this guide, and deals SRC Act provides that for the purposes of determining whether
with the effects of the impairment on the employee’s life. an impairment is permanent, the following matters shall be
Under subsection 4(1) of the SRC Act, for an employee who considered:
has suffered an injury resulting in a permanent impairment, it
(a) the duration of the impairment
means:
(b) the likelihood of improvement in the employee’s condition
‘loss or damage of a non-economic kind suffered by the
employee (including pain and suffering, a loss of expectation of (c) whether the employee has undertaken all reasonable
life or a loss of the amenities or enjoyment of life) as a result of rehabilitative treatment for the impairment
that injury or impairment and of which the employee is aware’. (d) any other relevant matters.
Non-economic loss may be characterised as the ‘lifestyle Thus, a loss, loss of the use, damage, or malfunction, will be
effects’ of an impairment. ‘Lifestyle effects’ are a measure of permanent if it is likely, in some degree, to continue indefinitely.
an individual’s mobility and enjoyment of, and participation For this purpose, regard shall be had to any medical opinion
in, social relationships, and recreation and leisure activities. concerning the nature and effect (including possible effect) of the
The employee must be aware of the losses suffered. While impairment, and the extent, if any, to which it may reasonably
employees may have equal ratings of whole person impairment be capable of being reduced or removed.
it would not be unusual for them to receive different ratings for
non-economic loss because of their different lifestyles.
11
4. PRE-EXISTING CONDITIONS AND AGGRAVATION assigned to an employee’s impairment by reference to the
relevant description in this guide.
Where a pre-existing or underlying condition is aggravated
by a work-related injury, only the impairment resulting from It may be necessary in some cases to have regard to a
the aggravation is to be assessed. However, an assessment number of chapters within Part 1 of this guide when assessing
should not be made unless the effects of the aggravation of the the degree of whole person impairment which results from
underlying or pre-existing condition are considered permanent. compensable injury.
In these situations, the pre-existing or underlying condition
Where a table specifies a degree of impairment because of a
would usually have been symptomatic prior to the work-related
surgical procedure, the same degree of impairment applies if the
injury and the degree of permanent impairment resulting from
same loss of function has occurred due to a different medical
that condition is able to be accurately assessed.
procedure or treatment.
If the employee’s impairment is entirely attributable to the pre-
existing or underlying condition, or to the natural progression of 6. MALIGNANCIES AND CONDITIONS RESULTING IN MAJOR
such a condition, the assessment for permanent impairment is SYSTEMIC FAILURE
nil.
Conditions such as cancer, HIV infection, diabetes, asbestosis,
Where the pre-existing or underlying condition was previously mesothelioma and others, often with terminal consequences,
asymptomatic, all the permanent impairment arising from the may result in failure or impairment of multiple body parts or
work-related injury is compensable. systems.
Assessments should be made of the impairment suffered in each

5. THE IMPAIRMENT TABLES
of the affected body parts and systems and combined using the
Part 1, Division 1 of this guide is based on the concept of whole combined values chart in Part 1, Appendix 1.
person impairment which is drawn from the American Medical
Association’s Guides to the Evaluation of Permanent Impairment
5th edition 2001.
Division 1 assembles into groups, according to body system,

detailed descriptions of impairments. The extent of each
impairment is expressed as a percentage value of the whole,
normal, healthy person. Thus, a percentage value can be
12
7. PERCENTAGES OF IMPAIRMENT 9. COMBINED VALUES
Most tables in Part 1, Division 1 provide impairment values Impairment is system or function based. A single injury may
expressed as fixed percentages. Where such a table is give rise to multiple losses of function and, therefore, multiple
applicable in respect of a particular impairment, there is no impairments. When more than one table applies in respect
discretion to choose an impairment value not specified in that of that injury, separate scores should be allocated to each
table. For example, where 10% and 20% are the specified functional impairment. To obtain the whole person impairment
values, there is no discretion to determine the degree of in respect of that injury, those scores are then combined using
impairment as 15%. the combined values chart (see Part 1, Appendix 1) unless the
notes in the relevant section specifically stipulate that the scores
Where a table provides for impairment values within a range,
are to be added. (For instance, see table 9.8.1).
consideration will need to be given to all criteria applicable
to the condition, which includes performing activities of daily Where there is an initial injury (or pre-existing condition) which
living and an estimate of the degree to which the medical results in impairment, and a second injury which results in
impairment interferes with these activities. In some cases, impairment to the same bodily part, system or function the
additional information may be required to determine where to pre-existing impairment must be disregarded when assessing
place an individual within the range. The person conducting the degree of impairment of the second injury. The second injury
the assessment must provide written reason why he or she should be assessed by reference to the functional capacities of a
considers the selected point within the range as clinically normal healthy person. The final scores are then added together.
justifiable.
Where two or more injuries give rise to different whole person
For further information relating to the application of impairments, each injury is to be assessed separately and the
this guide, please contact the Comcare Permanent final scores for each injury (including any combined score for a
Impairment Guide Helpdesk on 1300 366 979 or email particular injury) added together.
PI.Guide@comcare.gov.au.
It is important to note that whenever the notes in the relevant
section refer to combined ratings, the combined values chart
8. COMPARING ASSESSMENTS UNDER ALTERNATIVE TABLES
must be used, even if no reference is made to the use of that
Unless there are instructions to the contrary, where two or more chart.
tables (or combinations of tables) are equally applicable to
an impairment, the decision-maker must assess the degree of
permanent impairment under the table or tables which yields or
yield the most favourable result to the employee.
13
10. CALCULATING THE ASSESSMENT 12. EXCEPTIONS TO USE OF PART 1 OF THIS GUIDE
Where relevant, a statement is included in the chapters of Part 1, In the event that an employee’s impairment is of a kind that
Division 1 which indicates: cannot be assessed in accordance with the provisions of Part 1
of this guide, the assessment is to be made under the American
> the manner in which tables within that chapter may (or may
Medical Association’s Guides to the Evaluation of Permanent
not) be combined
Impairment 5th edition 2001.
> whether an assessment made in that chapter can be
combined with an assessment made in another chapter in An assessment is not to be made using the American Medical
assessing the degree of whole person impairment. Association’s Guides to the Evaluation of Permanent Impairment
for:
There are some special circumstances where addition of scores
> mental and behavioural impairments (psychiatric
rather than combination is required. These circumstances are
conditions)
specified in the relevant sections and tables in Part 1 of this
guide. > impairments of the visual system
> hearing impairment
11. ORDERING OF ADDITIONAL INVESTIGATIONS
> chronic pain conditions, except in the case of migraine or
As a general principle, the assessing medical practitioner should tension headaches. (For complex regional pain syndromes
not order additional radiographic or other investigations solely affecting the upper extremities, see Part 1, Chapter 9 –
for impairment evaluation purposes, unless the investigations 9.13.3 Complex Regional Pain Syndrome).
are specifically required in the relevant chapter of Part 1 of this
Any reference in this guide to the American Medical Association’s
guide.
Guides to the Evaluation of Permanent Impairment is a reference
to the 5th edition 2001.
14
PART 1
GLOSSARY
Definitions in italics are from subsection 4(1), 5A(1) and 5B(1) of but does not include a disease, injury or aggravation suffered as
the SRC Act. a result of reasonable administrative action taken in a reasonable
manner in respect of the employee’s employment.
Activities of daily living are those activities that an employee
needs to perform to function in a non-specific environment (that Loss of amenities means the effects on mobility, social
is, to live). Performance of Activities of Daily Living is measured relationships and recreation and leisure activities.
by reference to primary biological and psychosocial function.
Non-economic loss in relation to an employee who has suffered
Ailment means any physical or mental ailment, disorder, defect an injury resulting in a permanent impairment, means loss or
or morbid condition (whether of sudden onset or gradual damage of a non-economic kind suffered by the employee
development). (including pain and suffering, a loss of expectation of life or a loss
of the amenities or enjoyment of life) as a result of that injury or
Disease means:
impairment and of which the employee is aware.
(a) an ailment suffered by an employee
Pain means physical pain.
(b) an aggravation of such an ailment
Suffering means the mental distress resulting from the accepted
that was contributed to, to a significant degree, by the employee’s conditions or impairment.
employment by the Commonwealth or a licensee.
Whole person impairment (or WPI) is the methodology used
Impairment means the loss, the loss of the use, or the damage for expressing the degree of impairment of a person, resulting
or malfunction, of any part of the body or of any bodily system or from an injury, as a percentage. WPI is based on the American
function or part of such system or function. Medical Association’s Guides to the Evaluation of Permanent
Impairment. WPI is a medical quantification of the nature
Injury means:
and extent of the effect of an injury or disease on a person’s
(a) a disease suffered by an employee functional capacity including Activities of Daily Living. This guide
(b) an injury (other than a disease) suffered by an employee, presents descriptions of impairments in chapters and tables
that is a physical or mental injury arising out of, or in the according to body system. The extent of each impairment is
course of, the employee’s employment expressed as a percentage value of the functional capacity of a
normal healthy person.
(c) an aggravation of a physical or mental injury (other than
a disease) suffered by an employee (whether or not that
injury arose out of, or in the course of, the employee’s
employment), that is an aggravation that arose out of, or in
the course of, that employment
15
PART 1
DIVISION 1
ASSESSMENT OF THE DEGREE

OF AN EMPLOYEE’S PERMANENT
IMPAIRMENT RESULTING FROM
AN INJURY
16
CHAPTER 1—THE CARDIOVASCULAR SYSTEM
1.0 INTRODUCTION 17
1.1 CORONARY ARTERY DISEASE 18
1.2 HYPERTENSION 22
1.3 ARRHYTHMIAS 24
1.4 PERIPHERAL VASCULAR DISEASE OF THE LOWER EXTREMITIES 25
1.5 PERIPHERAL VASCULAR DISEASE OF THE UPPER EXTREMITIES 26
1.6 RAYNAUD’S DISEASE 27
17
1.0 INTRODUCTION
In conducting an assessment, the assessor must have regard to the principles of assessment (see pages 9-13) and the definitions
contained in the glossary (see page 14).
WPI ratings derived from tables in this chapter may be combined with WPI ratings from other tables where there is co-existent disease
(for example, cardiomyopathy, ischaemic heart disease, congenital heart disease, valvular heart disease).
‘Activities of daily living’ are activities which an employee needs to perform to function in a non-specific environment (that is, to live).
Performance of activities of daily living is measured by reference to primary biological and psychosocial function.
For the purposes of Chapter 1, activities of daily living are those in Figure 1-A (see below).
Figure 1-A: Activities of daily living
Activity Examples
Self care, personal hygiene Bathing, grooming, dressing, eating, eliminating.
Communication Hearing, speaking, reading, writing, using keyboard.
Standing, sitting, reclining, walking, stooping, squatting, kneeling, reaching, bending, twisting,
Physical activity
leaning, carrying, lifting, pulling, pushing, climbing, exercising.
Sensory function Tactile feeling.
Hand functions Grasping, holding, pinching, percussive movements, sensory discrimination.
Travel Driving or travelling as a passenger.
Sexual function Participating in desired sexual activity.
Sleep Having a restful sleep pattern.
Social and recreational Participating in individual or group activities, sports activities, hobbies.
Chapter 1 does not cover impairments arising from cardiomyopathy, congenital heart disease, valvular heart disease, and pericardial
heart disease. Where relevant, the degree of impairment arising from these conditions should be assessed in accordance with the
appropriate table from the American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition 2001.
18
For post-thrombotic syndrome, assessments under Tables 1.4 and 1.5 (peripheral vascular disease, see page 25) are an alternative
to Table 13.4: Thrombotic Disorders (see Chapter 13 – The Haematopoietic System). WPI ratings from Tables 1.4 and 1.5 must not
be combined with a WPI rating from Table 13.4. Tables 1.4 and 1.5 should be used as the primary guide for assessing peripheral
complications of thrombosis.
Employees who have permanent cardiac limitation secondary to massive pulmonary embolism should be assessed under Chapter 1.
A WPI rating assessed in these circumstances may not be combined with a rating from Table 13.4.
1.1 CORONARY ARTERY DISEASE
Steps for assessment are as follows.
Using Figure 1-B (see over page), determine the symptomatic level of activity in METS according to age and gender.
Step 1 Figure 1-B may be used to assess conditions affecting left ventricular function (LVF) (including ischaemic heart disease,
rheumatic heart disease, and hypertension).
Using Table 1.1 (see over page), refer to any one of pathology (column 3), drug therapy (column 4), or intervention
Step 2
(column 5), to identify the degree of impairment within the range of impairments for that symptomatic level of activity.
19
Figure 1-B (see below) may be used for the assessment of symptomatic impairment caused by ischaemic heart disease,
hypertension, cardiomyopathy, or rheumatic heart disease.
Figure 1-B: Symptomatic level of activity in METS according to age and gender
Age and Symptomatic level of activity in METS

gender 1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 10+
18-30 M D D D C C B B B A A
18-30 F D D C C B B A A A
31-40 M D D D C C B B A A
31-40 F D D C B B B A
41-50 M D D C C B B A A
41-50 F D D C B B A A
51-60 M D D C B B A A A
51-60 F D D C B B A A
61-70 M D D C B B A A
61-70 F D D B B A A
70+ M D C B B A
70+ F D C B A A
20
Table 1.1: Coronary artery disease
See notes following Table 1.1 for further details regarding abbreviations and symbols used in columns 3, 4 and 5.
Column 2
Column 1 Column 3 Column 4 Column 5
Level of activity in METS
% WPI Pathology Drug therapy Intervention
for age and gender
5 A Not applicable Not applicable Not applicable
10 A + + Not applicable
15 A ++ ++ PTCA
20 A +++ +++ CABG/Tx
25 B + + Not applicable
30 B ++ ++ PTCA
40 B +++ +++ CABG/Tx
50 C + + Not applicable
60 C ++ ++ PTCA
65 C +++ +++ CABG/Tx
75 D + + Not applicable
85 D ++ ++ PTCA
95 D +++ +++ CABG/Tx
21
Notes to Table 1.1 (iii) Myocardial infarction (MI):
+ no previous MI
1. In Table 1.1, not applicable means the criterion is not
applicable to the specified level of impairment. ++ previous possible MI (equivocal changes in
ECG/cardiac enzymes)
2. Pathology—column 3.
+++ previous definite MI (unequivocal changes
(i) Coronary artery disease: in ECG/cardiac enzymes: typical evolution of
+ either <50% stenosis in one or more ST/T segments, or development of significant Q
coronary arteries, or single vessel disease > waves, or enzyme rise > 3 times upper limit of
50% stenosis (except proximal left anterior normal).
descending [LAD] and left main coronary artery (iv) Arrhythmias
[LMCA])
Assessed under Table 1.3—Arrhythmias (see page 24).
++ either >50% stenosis in two vessels, or >50%
stenosis in proximal LAD, or <50% stenosis in 3. Drug therapy (continuous) —Column 4.
LMCA + one or two drugs
+++ either >50% stenosis in 3 vessels, or LMCA ++ three or four drugs
>50% stenosis, or severe diffuse end organ
+++ five or more drugs.
disease.
4. Intervention—column 5.
(ii) Ischaemic left ventricular dysfunction:
+ left ventricular ejection fraction (LVEF) 40-50% PTCA means percutaneous transluminal coronary
++ LVEF 30-40% angioplasty and/or stenting.
+++ either LVEF < 30%, or LV aneurysm. CABG means coronary artery bypass grafting.
Tx means heart transplant.

22
1.2 HYPERTENSION Table 1.2.1: Diastolic hypertension
Either diastolic hypertension (section 1.2.1) or systolic See note immediately following Table 1.2.1 for explanation of
hypertension (section 1.2.2 on the following page) may be symbols used in the final column (drug therapy).
assessed, whichever provides the higher WPI rating.
Level of
1.2.1 Diastolic hypertension activity in
% WPI Usual DBP Drug therapy
METS for age
Hypertensive cardiomyopathy can be assessed using the and gender
American Medical Association’s Guides to the Evaluation of 5 A >90 +
Permanent Impairment 5th edition 2001.
10 A >100 ++
Functional class (determined in accordance with Figure 1-B,
15 A >110 +++
see page 19) is the primary criterion for assessment. Level of
diastolic blood pressure (DBP) and therapy (see Table 1.2.1) 20 B >90 +
are secondary criteria for assessment. 25 B >100 ++
For assessment use either usual DBP, or therapy, for a given 30 B >110 +++
functional class, whichever provides the greater WPI rating. 35 C >90 +
If DBP is consistently >120 on optimal therapy, one higher
functional class may be assigned. 40 C >100 ++
45 C >110 +++
50 D >90 +
55 D >100 ++
60 D >110 +++
Note to Table 1.2.1
1. Drug therapy (continuous)—final column of Table 1.2.1:

+ one drug
++ two drugs
+++ three or more drugs.
23
1.2.2 Systolic hypertension Table 1.2.2: Systolic hypertension
Hypertensive cardiomyopathy can be assessed using the See note immediately following Table 1.2.2 for explanation of
American Medical Association’s Guides to the Evaluation of symbols used in the final column (drug therapy).
Permanent Impairment 5th edition 2001.
Symptomatic
Functional class (determined in accordance with Figure 1-B, level of
see page 19) is the primary criterion for assessment. Level of % WPI activity in Usual SBP Drug therapy
systolic blood pressure (SBP) and therapy (see Table 1.2.2) are METS for age
secondary criteria for assessment. and gender
5 A >160 +
10 A >160 ++
15 A >160 +++
20 B >170 +
25 B >170 ++
30 B >170 +++
35 C >180 +
40 C >180 ++
45 C >180 +++
50 D >190 +
55 D >190 ++
60 D >190 +++
Note to Table 1.2.2

1. Drug therapy (continuous):
+ one drug
++ two drugs
+++ three or more drugs.
24
1.3 ARRHYTHMIAS Table 1.3: Arrhythmias
Underlying cardiac disease can be assessed using other tables See note immediately following Table 1.3 for explanation of
in Chapter 1. symbols used in the final column (therapy).
Functional class (determined under Figure 1-C below), and % WPI Functional class Therapy
therapy (see Table 1.3), are used to determine the WPI rating.
5 I Nil
Figure 1-C: Definitions of functional class 10 I Drug(s)
15 I Surgery/cath/PPM/Device
Functional class Symptoms
20 II Nil
I No limitation of physical activity.
30 II Drug(s)
Slight limitation of physical activity.
Comfortable at rest and with ordinary, 40 II Surgery/cath/PPM/Device
II
light Activities of Daily Living.
45 III Nil
Greater activity causes symptoms.
50 III Drug(s)
Marked limitation of physical activity.
III Comfortable at rest. 55 III Surgery/cath/PPM/Device
Ordinary activity causes symptoms. 60 IV Not applicable
Inability to carry out any physical activity
IV
without discomfort. Note to Table 1.3
1. Therapy—column 3:
‘cath’ means either catheter ablation or catheter-

associated therapy for arrhythmia
‘PPM’ means permanent pacemaker
‘Device’ means implanted defibrillator.

25
1.4 PERIPHERAL VASCULAR DISEASE OF THE LOWER EXTREMITIES
Amputatees should not be assessed under Table 1.4. They should be assessed under Table 9.5: Lower extremity amputations (see
Chapter 9—The musculoskeletal system).
A WPI rating from Table 1.4 must not be combined with a WPI rating from Table 13.4: Thrombotic disorders (see Chapter 13—The
haematopoietic system).
Table 1.4: Peripheral vascular disease of the lower extremities
% WPI Signs and symptoms

0 The employee experiences neither intermittent claudication nor ischaemic pain at rest.
The employee has no difficulty with distances but experiences ischaemic pain on climbing either steps or
5
gradients.
10 The employee experiences claudication on walking 200 metres or more at an average pace on level ground.
The employee experiences claudication on walking more than 100 but less than 200 metres at average pace on
20
level ground.
30
level ground.
40
level ground.
50
level ground.
60 The employee experiences claudication on walking less than 25 metres at average pace on level ground.
70 The employee experiences ischaemic pain at rest.
26
1.5 PERIPHERAL VASCULAR DISEASE OF THE UPPER EXTREMITIES
Amputatees should not be assessed under Table 1.5. They should be assessed under Table 9.12.1: Upper extremity amputations, or
Table 9.12.2: Amputation of digits (see Chapter 9—The musculoskeletal system).
A WPI rating from Table 1.5 must not be combined with a WPI rating from Table 13.4: Thrombotic disorders (see Chapter 13—The
haematopoietic system).
Table 1.5 Peripheral vascular disease of the upper extremities
% WPI Symptoms Signs

5 Either no claudication or transient oedema. Calcification of arteries on X-ray.
Either no claudication or persistent oedema controlled
10 Dilatation of either arteries or veins.
by support.
15 As above. Either loss of pulse or healed ulcer or surgery.
Either claudication on strenuous exercise or persistent Either calcification of arteries on X-ray or dilatation of
20
oedema uncontrolled by support. either arteries or veins.
30 As above. Superficial ulcer.
40 As above. Either deep or widespread ulcer or surgery.
Either calcification of arteries on X-ray or dilatation of
45 Claudication on mild-moderate exertion.
either arteries or veins.
50 As above. Superficial ulcer.
55 As above. Either deep or widespread ulcer or surgery.
60 Rest pain/unable to exercise. Not applicable
27
1.6 RAYNAUD’S DISEASE Table 1.6: Raynaud’s disease
Functional class (determined according to Figure 1-C below) See note immediately following Table 1.6.
is the primary criterion for assessment. Signs of vasospastic
disease and therapy (see Table 1.6) are secondary criteria for Functional
% WPI Signs Therapy
assessment. class
5 I Nil. Nil.
Figure 1-C: Definitions of functional class
10 I Nil. Drug(s).
See note to immediately following Figure 1-C. 15 I Nil. Surgery.
Functional Class Symptoms Neither ulceration nor

20 II Drug(s).
trophic changes.
I No limitation of physical activity.
Either ulceration or
Slight limitation of physical activity. 25 II Drug(s).
trophic changes.
Comfortable at rest and with ordinary, light
II 30 II not applicable Surgery.
activities of daily living.
Greater activity causes symptoms. Neither ulceration nor
35 III Drug(s).
trophic changes.
Marked limitation of physical activity.
III Comfortable at rest. Either ulceration or
40 III Drug(s).
trophic changes.
Ordinary activity causes symptoms.
45 III Not applicable Surgery.
Inability to carry out any physical activity
IV
without discomfort. Not
50 IV Not applicable
applicable
Note to Figure 1-C
Note to Table 1.6
1. Figure 1-C also appears in Section 1.3—Arrhythmias, see
page 24. It is repeated here for ease of reference. 1. Therapy—final column of Table 1.6:
Surgery includes sympathectomy and local debridement.
Drug(s) means continuous therapy with one or more

drugs.
28
CHAPTER 2—THE RESPIRATORY SYSTEM
2.0 INTRODUCTION 29
2.1 ASSESSING IMPAIRMENT OF RESPIRATORY FUNCTION 29
2.2 ASTHMA AND OTHER HYPER-REACTIVE AIRWAYS DISEASES 31
2.3 LUNG CANCER AND MESOTHELIOMA 34
2.4 BREATHING DISORDERS ASSOCIATED WITH SLEEP 34
29
2.0 INTRODUCTION 2.1 ASSESSING IMPAIRMENT OF RESPIRATORY FUNCTION
In conducting an assessment, the assessor must have regard

2.1.1 Measurements
to the principles of assessment (see pages 9-13) and the
definitions contained in the glossary (see page 14). The most commonly recommended measurements for
determining respiratory impairment are:
The measure of impairment is the reduction in physiological
function below that found in health. > spirometry with measurement of the forced expiratory
volume at 1 second (FEV1) and forced vital capacity (FVC)
Respiratory impairment is quantified by the degree to which
> the transfer factor, or diffusing capacity of the lung, for
measurements of respiratory function are changed by the
carbon monoxide (TlCO), measured by the single breath
compensable injury or injuries, relative to values obtained in a
method.
healthy reference population of similar individuals.
However, the measurements used must be derived from either:
Conditions such as chronic obstructive airways disease and
chronic bronchitis are to be assessed according to the methods > the tests prescribed below where relevant (for example, in
used to measure loss of respiratory function. assessing asthma)
Employees who have permanent respiratory limitation secondary > where a test is not prescribed, from tests appropriate
to massive pulmonary embolism should be assessed under to assessing the impairments caused by the particular
Chapter 2. Any WPI rating awarded in these circumstances must compensable condition or conditions.
not be combined with a WPI rating from Table 13.4: Thrombotic
Other measurements commonly used to assess impairment
disorders (see Chapter 13—The haematopoietic system).
include:
> the lung volumes
> total lung capacity (TLC) and residual volume (RV)
> the response to a maximum exercise test including
measurement of the oxygen consumption at the maximum
workload able to be achieved (vO2max), and the degree of
arterial oxygen desaturation during exercise.
30
On occasion, other measurements may be needed to define Methods of measurement should conform to internationally
impairment accurately. For example: recognised standards in relation to the equipment used,
the procedure, and analysis of the data. Reference values
> the elastic and flow resistive properties of the lungs
(‘predicted’ normal values) should be representative of the
> respiratory muscle strength healthy population and be appropriate for ethnicity where
> arterial blood gases possible. Laboratories providing measurements used to assess
impairment should state the method(s) of measurement used,
> polysomnography (sleep studies)
and the source of the reference values used.
> echocardiography with estimation of pulmonary artery
pressure 2.1.3 Impairment rating
> quantitative ventilation-perfusion scans of the lung. Several professional groups have published criteria for rating the
severity of impairment based on spirometry, gas transfer and
Measurement of the partial pressures of oxygen and carbon
vO2max. These professional groups include the Thoracic Society
dioxide in arterial blood (PaO2 and PaCO2 respectively) are
of Australia and New Zealand (Abramson, 1996), the American
not usually required to assign impairment ratings accurately.
Thoracic Society (American Thoracic Society Ad Hoc Committee
However, individual variation may result in severe impairment
on Impairment/Disability Criteria, 1986), and the American
in gas exchange when other measures of function indicate only
Medical Association (2001). In general, measurements are
moderate impairment. Arterial PaO2 of <55 mm Hg and/or
expressed as a percentage of the predicted value (%P) and,
PaCO2 >50 mm Hg, despite optimal treatment, is evidence of
where several measurements are performed, the most abnormal
severe impairment and attracts a WPI rating of 70%.
result is used to classify the degree of impairment.
Measurements of arterial blood gases should be performed on
Severity of impairment is rated as shown in Table 2.1 over page.
two occasions with the employee seated.
This generic table can be used to assign WPI ratings using any
valid measurement for which there are predicted normal data.
2.1.2 Methods of measurement
Measurements must be performed in a manner consistent with

the methods used by a respiratory function laboratory accredited
by one or more of the following bodies:
> the Thoracic Society of Australia and New Zealand
> the Australian Sleep Society
> the Australian Council on Health Care Standards.
31
Table 2.1: Conversion of respiratory function values to 2.2 ASTHMA AND OTHER HYPER-REACTIVE AIRWAYS
impairment DISEASES
See note immediately following Table 2.1. Assessment of impairment due to asthma can be confounded
by the natural history of occupational asthma, by variably
% WPI Respiratory function %P severe airflow obstruction, and therefore variable FEV1, and by
0 >85 response to treatment.
10 85 to 76 For hyper-reactivity of airways due to occupational exposures,

assessment of impairment is made after:
20 75 to 66
> the diagnosis and cause are established
30 65 to 56
> exposure to the provoking factor is eliminated
40 55 to 51
> appropriate treatment of asthma is implemented.
50 50 to 44
60 45 to 41 Appropriate treatment follows the guidelines in the Asthma
Management Handbook 2002 (National Asthma Council, 2002,
70 40 to 36
5th edition, Melbourne: National Asthma Council of Australia),
80 35 a later edition of those guidelines, or later guidelines widely
accepted by the medical profession as representing best
Note to Table 2.1 practice.
1. %P = percentage of mean value for healthy individuals of Permanent impairment should not be assessed until 2 years
the same age, height and sex. after cessation of exposure to provoking factors as severity may
decrease during this period.
An impairment rating scale is set out in Figure 2-A (see page

33) and Table 2.2 (see page 34). The scale used in Figure 2-A
and Table 2.2 is modified to account for frequency of increased
impairment from asthma despite optimal treatment.
32
A score reflecting impairment from asthma is calculated by:
> adding the points scored for reduction in FEV1 %P
and either
> change in FEV1 with bronchodilator (reversibility)
or
> degree of bronchial hyperreactivity defined by the cumulative dose of metacholine, or histamine, required to decrease baseline
FEV1 by at least 20%
and
> measurement of FEV1, or peak flow (PF) rate, measured by the employee morning and evening, before and after aerosol
bronchodilator, for at least 30 days.
The number of days on which any valid measurement of FEV1 or PF is less than 0.85 x the mean of the six highest values of FEV1 or
PF during the monitoring period is to be expressed as a percentage of total days in the monitoring period.
The maximum impairment score from Figure 2-A is 11. One additional point is given, yielding a score of 12, if asthma cannot be
controlled adequately with maximal treatment. The score from Figure 2-A is converted to a WPI rating using Table 2.2.
33
Figure 2-A: Calculating asthma impairment score
See notes immediately following Figure 2-A.
FEV1, % P FEV1, % change PD20 % of Days lowest FEV1*

Score in FEV1 with
After bronchodilator or μmol is ≤0.85 highest FEV1
bronchodilator
0 >85 <10 >4.0 <6
1 76 to 85 10 to 19 0.26 to 4.0 6 to 24
2 66 to 75 20 to 29 0.063 to 0.25 25 to 34
3 56 to 65 30 ≤0.062 35 to 44
4 ≤55 45
Notes to Figure 2-A
1. Figure 2-A is based on scales proposed by: the American Thoracic Society (1993), as adapted in Tables 5-9 and 5-10 of
American Medical Association’s Guides to the Evaluation of Permanent Impairment (5th edition, 2001); and the Thoracic
Society of Australia and New Zealand (Abramson, 1996).
2. %P = percent predicted normal value.
3. PD20 = cumulative dose of inhaled metacholine aerosol causing a 20% decrease in FEV1.
4. * monitored twice daily before and after aerosol bronchodilator for at least 30 days during adequate treatment.
5. % of days = proportion of days any value of FEV1 (or of peak flow rate) is less than highest repeatable FEV1 (or peak flow rate)
x 0.85.
34
Table 2.2: WPI derived from asthma impairment score 2.4 BREATHING DISORDERS ASSOCIATED WITH SLEEP
% WPI Asthma impairment score Some disorders such as obstructive sleep apnoea, central
sleep apnoea, and hypoventilation during sleep, can cause
0 0
impairment which is not quantifiable by standard measurements
10 1 of respiratory function such as spirometry, diffusing capacity, or
response to exercise.
20 2
30 3 Obstructive sleep apnoea should be assessed using Table 2.4
(see page 36). Central sleep apnoea should be assessed using
40 4
Table 12.1.3: Sleep and arousal disorders (see Chapter 12—
45 5 The neurological system).
50 6 An overnight sleep study is used to define the severity of
55 7 sleep-related disorders of breathing and can be used to define
impairment after appropriate treatment has been implemented.
60 8
During the overnight sleep study there is continuous monitoring
65 9 of breathing pattern, respiratory effort, arterial oxygen saturation,
70 10 electrocardiogram, and sleep state. Results of sleep studies
cannot readily be expressed in terms of a percentage of
75 11 predicted values. Consequently, impairment is rated by
80 12 assigning scores to the degree of abnormality at sleep study
(Figure 2-B over page and Table 2.4 on page 36). These ratings
are based on frequency of disordered breathing, frequency of
2.3 LUNG CANCER AND MESOTHELIOMA
sleep disturbance, degree of hypoxaemia and, as appropriate,
Employees with lung cancers (other than mesothelioma) are hypercapnoea during sleep. In addition, degree of daytime
considered severely impaired at the time of diagnosis and are sleepiness is assessed using the Epworth sleepiness scale
given a WPI rating of 70%. (Johns, 1991).
If there is evidence of tumour, or if tumour recurs one year after Where vascular morbidity is present (for example, high blood
diagnosis is established, then the employee remains severely pressure or myocardial infarction) and is attributable to sleep
impaired and the WPI rating is increased to 80%. apnoea, impairment should be assessed using the relevant table
in Chapter 1—The cardiovascular system.
Employees with mesothelioma are considered severely impaired
and a WPI rating of 85 % is awarded upon diagnosis.
35
The total score derived from Figure 2-B below is the sum of the scores from each column: the maximum score is 12. This score is
converted to a WPI rating using Table 2.4.
Figure 2-B: Calculating obstructive sleep apnoea score
See notes immediately following Figure 2-B.
Epworth sleepiness Apnoeas + Respiratory arousals*/hr Cumulative sleep time,

Score
score hypopnoeas/hr of sleep of sleep mins, with SaO2 <90% #
0 <5 <5 <5 0
1 5 to 10 5 to 15 5 to 15 <15
2 11 to 17 16 to 30 16 to 30 15 to 45
3 >17 >30 >30 >45
Notes to Figure 2-B
1 *An arousal within 3 seconds of a sequence of breaths which meet the criteria for an apnoea, an hypopnoea, or a respiratory
effort related arousal, as defined by the American Academy of Sleep Medicine (1999).
2 #SaO2 = arterial oxygen saturation measured with a pulse oximeter.

36
Table 2.4: WPI derived from obstructive sleep apnoea
score
% WPI Sleep apnoea score

0 0
10 1
20 2
30 3
40 4
45 5
50 6
55 7
60 8
65 9
70 10
75 11
80 12
37
CHAPTER 3—THE ENDOCRINE SYSTEM
3.0 INTRODUCTION 38
3.1 THYROID AND PARATHYROID GLANDS 38
3.2 ADRENAL CORTEX AND MEDULLA 39
3.3 PANCREAS (DIABETES MELLITUS) 40
3.4 GONADS AND MAMMARY GLANDS 42
38
3.0 INTRODUCTION Where an employee has more than one of the conditions in
Table 3.1 below, combine the WPI ratings using the combined
values chart (see Appendix 1).
definitions contained in the glossary (see page 14). Permanent secondary impairment resulting from persistent
hyperparathyroidism (such as renal calculi or renal failure)
The degree of impairment caused by secondary conditions
should be assessed under the relevant system (for example,
(such as peripheral neuropathy, or peripheral vascular disease)
Chapter 10—The urinary system).
accompanying an endocrine system condition must also be
assessed under the relevant tables in other chapters, including Table 3.1: Thyroid and parathyroid glands
tables in Chapter 10—The urinary system.
% WPI Criteria
In this circumstance, using the combined values chart (Appendix
Hyperparathyroidism—symptoms and signs
1), WPI ratings derived from the relevant tables in other chapters
readily controlled by medication or other treatment
are combined with WPI ratings from tables in Chapter 3. such as surgery.
0 Hypoparathyroidism—symptoms and signs readily
3.1 THYROID AND PARATHYROID GLANDS controlled by medication.
Hypothyroidism adequately controlled by
Hyperthyroidism is not considered to cause permanent replacement therapy.
impairment because the condition is usually amenable to
Hypothyroidism where the presence of a disease
treatment. Where visual and/or cosmetic effects resulting in another body system prevents adequate
from exophthalmos persist following correction of the replacement therapy.
hyperthyroidism, a WPI rating may be derived from: Hyperparathyroidism—persisting mild
10-15
hypercalcaemia, despite medication.
> Chapter 4—Disfigurement and skin disorders
Hypoparathyroidism—symptoms and signs such
> Chapter 6—The visual system (see section 6.5—Other as intermittent hyper or hypocalcaemia not readily
conditions causing permanent deformities causing up to controlled by medication.
10% impairment of the whole person). Hyperparathyroidism—persisting severe
30 hypercalcaemia with serum calcium above
Hyperparathyroidism is usually amenable to correction by 3.0mmol/l, despite medication.
surgery. If surgery fails, or the employee cannot undergo surgery
for sound medical reasons, long-term therapy may be needed. If Notes to Table 3.1
so, permanent impairment can be assessed after stabilisation of 1 Assessors should refer to the Principles of Assessment
the condition with medication, in accordance with the criteria in for guidance on awarding an impairment value within a
Table 3.1. range.
39
3.2 ADRENAL CORTEX AND MEDULLA
Where Cushing’s syndrome is present, Table 3.2 below should be used to evaluate impairment from the general effects of
hypersecretion of adrenal steroids (for example, myopathy, easy bruising, and obesity).
Using the combined values chart (see Appendix 1), WPI ratings derived from Table 3.2 may be combined with WPI ratings for
specific associated secondary impairments (for example, fractures or diabetes mellitus).
Table 3.2: Adrenal cortex and medulla
% WPI Criteria
Cushing’s syndrome—surgically corrected by removal of adrenal adenoma or removal of the source of ectopic ACTH
secretion.
0
Phaeochromocytoma—benign tumour, surgically removed or removable where hypertension has not led to the
development of permanent cardiovascular disease.
Hypoadrenalism—symptoms and signs readily controlled with replacement therapy.
5 Cushing’s syndrome due to moderate doses of glucocorticoids (for example, less than equivalent of 15mg of
prednisolone per day) where glucocorticoids will be required long-term.
10 Cushing’s syndrome—surgically corrected by removal of pituitary adenoma or adrenal carcinoma.
15 Cushing’s syndrome—due to:
> bilateral adrenal hyperplasia treated by adrenalectomy
> large doses of glucocorticoids (for example, equivalent of at least 15 mg of prednisolone per day) where
glucocorticoids will be required long-term
> inadequate removal of source of ectopic ACTH secretion.
Phaeochromocytoma—malignant tumour where signs and symptoms of catecholamine excess can be controlled by
blocking agents.
Hypoadrenalism—recurrent episodes of adrenal crisis during acute illness or in response to significant stress.
Phaeochromocytoma—metastatic malignant tumour where signs and symptoms of catecholamine excess cannot be
70
controlled by blocking agents or other treatment.
40
3.3 PANCREAS (DIABETES MELLITUS)
Where diabetic retinopathy has led to visual impairment, the visual impairment should be assessed using Chapter 6—The visual
system.
Where diabetes has led to secondary impairment of renal function, that impairment should be assessed using Chapter 10—The
urinary system.
Using the combined values chart (see Appendix 1), WPI ratings derived under Table 3.1 and Table 3.2 may be combined with WPI
ratings from Table 3.3 over page.
Microangiopathy may be manifest as retinopathy (background, proliferative, or maculopathy) and/or albuminuria measured
with a timed specimen of urine. Where there is an overnight collection, the upper limit of normal is 20 µg/minute. Where a 24
hour specimen is collected, the upper limit of normal is 30mg/day. Albuminuria must be documented in at least two out of three
consecutive urine specimens collected.
41
Table 3.3: Pancreas (diabetes mellitus)
See notes to Table 3.3 on the following page.
% WPI Type Therapy Microvascular complications

Dietary restrictions with or without oral hypoglycaemic agents Microangiopathy is not
5 Type 2 (NIDDM)
give satisfactory control. present.
Microangiopathy and/or
Dietary restrictions with or without oral hypoglycaemic agents
10 Type 2 (NIDDM) significant neuropathy are
give satisfactory control.
present.
Microangiopathy is not
15 Type 1 (IDDM) Dietary restrictions and insulin give satisfactory control.
present.
Dietary restrictions and insulin give satisfactory control Microangiopathy and/or
Type 1 (IDDM)
20 Type 2 (NIDDM) where dietary restrictions & insulin and/or oral significant neuropathy are
Type 2 (NIDDM) present.
hypoglycaemic agents give satisfactory control.
Dietary restrictions and insulin do not give satisfactory control
Microangiopathy is not
25 Type 1 (IDDM) and frequent episodes of severe hypoglycaemia requiring the
present.
assistance of another person have been documented.
30 Type 1 (IDDM) and frequent episodes of severe hypoglycaemia requiring the Microangiopathy is present.
Microangiopathy is present as
40 Type 1 (IDDM) and frequent episodes of severe hypoglycaemia requiring the
well as significant neuropathy.
Symptomatic hypoglycaemia due to metastatic tumour (usually
50
insulinoma), uncontrolled by medication (such as diazoxide).
42
Notes to Table 3.3 Table 3.4: Gonads and mammary glands
1. For the purposes of Table 3.3, the degree of control % WPI Criteria
is defined by reference to the glycated haemoglobin
measurement (HbA1c) where: Diminished or absent level of gonadal hormones
in either sex.
> 4%-6% is the non-diabetic range 0
Abnormally high level of gonadal hormones in
either sex.
> <8% is indicative of satisfactory control for the
purposes of this table. Loss of one or both breasts in male.
Loss of whole or part of one breast in female.
2. ‘Significant neuropathy’ means persistent symptoms of 5
Gynaecomastia in male where pain interferes with
peripheral or autonomic neuropathy which interfere with
everyday activities—not controlled by medication.
quality of life to a considerable degree.
10 Loss of whole or part of both breasts in female.
3. ‘NIDDM’ means non-insulin dependent diabetes mellitus.
4. ‘IDDM’ means insulin dependent diabetes mellitus.
3.4 GONADS AND MAMMARY GLANDS
Impairments resulting from inability to reproduce, and other

impairments associated with gonadal dysfunction, are assessed
under Chapter 11—The reproductive system.
Loss of one or both breasts in females should also be assessed

using Table 4.3: Bodily disfigurement (see Chapter 4—
Disfigurement and skin disorders). Using the combined values
chart (see Appendix 1), a WPI rating derived from Table 4.3
may be combined with a WPI rating derived from Table 3.4.
43
CHAPTER 4—DISFIGUREMENT AND SKIN DISORDERS
4.0 INTRODUCTION 44
4.1 SKIN DISORDERS 44
4.2 FACIAL DISFIGUREMENT 47
4.3 BODILY DISFIGUREMENT 48
44
4.0 INTRODUCTION 4.1 SKIN DISORDERS
In conducting an assessment, the assessor must have regard For the purposes of Table 4.1: Skin disorders:
> ‘intermittent treatment’ means a course of treatment leading
definitions contained in the glossary (see page 14).
to a break, treatment alternately ceasing and beginning
Impairments assessed under Chapter 4 include those caused again
by secondary conditions accompanying an endocrine system > ‘constant treatment’ means treatment that continues on a
condition. A WPI rating from a table in Chapter 3—The regular basis without interruption
endocrine system should be combined with WPI ratings resulting
> ‘complex treatment’ means treatment that requires regular
from the secondary conditions assessed under Chapter 4.
and close supervision, usually by a dermatologist.
Loss of one or both breasts in females should be assessed Such supervision could involve regular blood tests and
under both: relevant regular physical examinations, such as blood
pressure measurement. Complex treatments would
> Table 3.4: Gonads and mammary glands (see Chapter 3—
be expected to have potential adverse side effects.
The endocrine system)
Categories of drugs forming a part of, or the whole of,
> Table 4.3: Bodily disfigurement complex treatment would include high doses of systemic
> and the resulting WPI ratings combined. corticosteroids, or immunosuppressive medications such as
azathioprine, methotrexate and cyclosporin. Phototherapy,
In cases where two or three of Tables 4.1, 4.2 and 4.3 apply, photochemotherapy, or photophoresis, would also be
WPI ratings from each table can be combined using the considered complex treatments.
combined values chart (see Appendix 1).
Column 4 in Table 4.1 is referenced to Figure 4-A: Activities of
WPI ratings awarded under Table 4.2 cannot be combined daily living, on page 46.
with WPI ratings arising under section 6.4—Other ocular
abnormalities, or section 6.5—Other conditions causing
permanent deformities causing up to 10% impairment of the
whole person (see Chapter 6—The visual system).
45
Table 4.1: Skin disorders
Column 4
% WPI Signs and symptoms Requirement for treatment Activities of daily living
affected
0 Absent None, intermittent up to 2
5 Absent Constant up to 2
5 Intermittent Intermittent or constant up to 2
Present on a daily basis for periods aggregating three or
10 Intermittent or constant 1 or more
more months per year, but less than six months per year.
Present on a daily basis for period aggregating six or more
months per year, but less than nine months per year.
Present on a daily basis for periods aggregating nine
months per year or more.
Present on a daily basis for periods aggregating nine
25 Constant 4 or more
months per year or more.
Present on a daily basis for period aggregating nine months
30 Constant and complex 6 or more
per year or more.
46
Figure 4-A: Activities of daily living—See Column 4 in Table 4.1
No. Activities Examples

1 Self care, personal hygiene Bathing, grooming, dressing, eating, eliminating.
2 Communication Hearing, speaking, reading, writing, using keyboard.
Standing, sitting, reclining, walking, stooping, squatting, kneeling, reaching, bending,
3 Physical activity
twisting, leaning, carrying, lifting, pulling, pushing, climbing, exercising.
4 Sensory function Tactile feeling.
5 Hand functions Grasping, holding, pinching, percussive movements, sensory discrimination.
6 Travel Driving or travelling as a passenger.
7 Sexual function Participating in desired sexual activity.
8 Sleep Having a restful sleep pattern.
9 Social and recreational Participating in individual or group activities, sports activities, hobbies.
47
4.2 FACIAL DISFIGUREMENT
Table 4.2: Facial disfigurement
% WPI Criteria
No structural changes.
Normal facial appearance.
0 Hyperpigmentation, depigmentation, redness or telangiectasis occupying less than 10% of facial area (excluding
actinic damage).
Scarring that does not significantly alter the appearance of the face.
Hyperpigmentation, depigmentation, redness or telangiectasis occupying 10% or more of the facial area (excluding
actinic damage)
or
5 Scars and/or skin grafts occupying less than 5% of facial area that significantly alter the appearance of the face
or
Depressed cheek, nasal or frontal bones.
Total or partial loss of one external ear.
Scars and/or skin grafts occupying 5-15% of facial area that significantly alter the appearance of the face
or
10 Total or partial loss of both external ears
or
Loss of less than 50% of the nose.
Scars and/or skin grafts occupying 15-25% of facial area that significantly alter the appearance of the face
15 or
Loss of 50-75% of the nose.
Scars and/or skin grafts occupying more than 25% of facial area that significantly alter the appearance of the face
20 or
Loss of more than 75% of the nose.
48
4.3 BODILY DISFIGUREMENT
Table 4.3: Bodily disfigurement
% WPI Criteria
Normal body appearance.
0
Scars and/or skin grafts occupying less than 10% of body area.
5 Scars and/or skin grafts occupying 11% to 20% of body surface.
Scars and/or skin grafts occupying 21% to 40% of body area
10 or
Tissue loss causing noticeable unilateral alteration of body silhouette.
15 Scars and/or skin grafts occupying 41% to 60% of body area.
Scars and/or skin grafts occupying 61% to 80% of body area
20 or
Tissue loss causing noticeable bilateral alteration of body silhouette.
25 Scars and/or skin grafts occupying more than 80% of body surface area.
49
CHAPTER 5—PSYCHIATRIC CONDITIONS
5.0 INTRODUCTION 50
5.1 PSYCHIATRIC CONDITIONS 51
50
5.0 INTRODUCTION
In conducting an assessment, the assessor must have regard to the principles of assessment (see pages 9-13) and the definitions
contained in the glossary (see page 14).
For the purposes of Chapter 5, activities of daily living are those in Figure 5-A (see below). The examples provided below are not
exhaustive and should not be seen as a substitute for assessor discretion when making decisions about impairment ratings.
Activity Examples
Physical activity
51
5.1 PSYCHIATRIC CONDITIONS
Table 5.1: Psychiatric conditions
See note to Table 5.1 on page 53.
% WPI Description of level of impairment

Reactions to stresses of daily living without loss of personal or social efficiency
0 and
Capable of performing activities of daily living without supervision or assistance.
Despite the presence of one of the following employee is capable of performing activities of daily living without
supervision or assistance:
5 > reactions to stresses of daily living with minor loss of personal or social efficiency
> lack of conscience directed behaviour without harm to community or self
> minor distortions of thinking.
Despite the presence of more than one of the following employee is capable of performing activities of daily living
without supervision or assistance:
> lack of conscience directed behaviour without harm to community or self
> minor distortions of thinking.
Any one of the following accompanied by a need for some supervision and direction in activities of daily living:
> reactions to stresses of daily living which cause modification to daily living patterns
15
> marked disturbances in thinking
> definite disturbance in behaviour.
Any two of the following accompanied by a need for some supervision and direction in activities of daily living:
> reactions to stresses of daily living which cause modification of daily living patterns
20
> marked disturbance in thinking
Table 5.1 continued on following page

52
Table 5.1 (continued)
% WPI Description of level of impairment

All of the following accompanied by a need for some supervision and direction in activities of daily living:
25
> definite disturbances in behaviour.
Any one of the following accompanied by a need for supervision and direction in activities of daily living:
> hospital dischargees who require daily medication or regular therapy to avoid readmission
30
> loss of self-control and/or inability to learn from experience resulting in potential for considerable damage to self or
community.
More than one of the following accompanied by a need for supervision and direction in activities of daily living:
> hospital dischargees who require daily medication or regular therapy to avoid readmission
40
> loss of self-control and/or inability to learn from experience resulting in potential for considerable damage to self or
community.
One of the following:
50 > severe disturbances of thinking and/or behaviour entailing potential or actual harm to self and/or others
> need for supervision and direction in a confined environment.
Both of the following:
60 > severe disturbances of thinking and/or behaviour which entail potential or actual harm to self and/or others
Very severe disturbance in all aspects of thinking and behaviour requiring constant supervision and care in a confined
90
environment, and assistance with all activities of daily living
53
Notes to Table 5.1
1. Table 5.1 includes psychoses, neuroses, personality

disorders and other diagnosable conditions. The
assessment should be made on optimum medication at a
stage where the condition is reasonably stable.
2. Supervision means the immediate presence of a suitable

person, responsible in whole or in part for the care of the
employee.
3. Assistance means the provision of assistance to the

employee in performing the activities of daily living by a
suitable person, responsible in whole or in part for the
care of the employee
4. Direction means the provision of direction to the employee

by a suitably qualified person, responsible in whole or in
part for the care of the employee
5. Suitable person means a person capable of responsibly

caring for the employee in an appropriate way
6. Suitably qualified person means a person with the

necessary qualifications, experience and skills to provide
appropriate direction to the employee. Such persons
include medical practitioners, nursing staff and clinical
psychologists.
54
CHAPTER 6—THE VISUAL SYSTEM
6.0 INTRODUCTION 55
6.1 CENTRAL VISUAL ACUITY 58
6.2 DETERMINING LOSS OF MONOCULAR VISUAL FIELDS 61
6.3 ABNORMAL OCULAR MOTILITY AND BINOCULAR DIPLOPIA 62
6.4 OTHER OCULAR ABNORMALITIES 63
6.5 OTHER CONDITIONS INVOLVING PERMANENT DEFORMITIES CAUSING UP TO 10%
IMPAIRMENT OF THE WHOLE PERSON 63
6.6 CALCULATION OF VISUAL SYSTEM IMPAIRMENT FOR BOTH EYES 63
55
6.0 INTRODUCTION Impairments assessed under Chapter 6 include those caused
by secondary conditions accompanying an endocrine system
condition. An impairment assessed under Chapter 3—The
endocrine system should be combined with those resulting from
definitions contained in the glossary (see pages page 14).
the secondary conditions assessed under Chapter 6.
Chapter 6 provides a standard method for examining the visual
WPI ratings from Table 4.2: Facial disfigurement (see Chapter
system, and for calculating the extent of any visual impairment.
4—Disfigurement and skin disorders), cannot be combined with
Impairment is any loss or abnormality in the anatomy or
WPI ratings arising from either:
function of the visual system. The visual system includes the
eyes, the ocular adnexa, and the visual pathways. > section 6.4—Other ocular abnormalities
> section 6.5—Other conditions causing permanent
All visual tests are standardised and impairment assessment
deformities causing up to 10% impairment of the whole
follows a strict protocol in order to ensure that different
person.
ophthalmologists can closely reproduce results. Wherever
possible, impairment assessment should be performed by an Facial nerve injury complicated by visual changes, such
ophthalmologist. as occurs with corneal desiccation and scarring, rates as a
significant impairment. Such an impairment is assessed under
Visual impairment exists when there is deviation from any of the
Chapter 6 and a resulting WPI rating may be combined with
normal functions of the eye.
a WPI rating from Table 12.5.4: The Facial Nerve (VII) (see
Among the types of visual impairment listed below, the first Chapter 12—The neurological system).
three (6.1-6.3) contribute the most to the overall impairment
(numbers correspond to sections in Chapter 6): Steps in determining whole person impairment
6.1 Central visual acuity for near and far objects See Figure 6-A on the following page for steps in deriving a
6.2 Monocular visual field visual system impairment rating. Use Table 6.1 (on page 57) to
convert a visual system impairment rating to a WPI rating.
6.3 Ocular motility
6.4 Other ocular abnormalities
6.5 Other conditions involving permanent deformities causing
up to 10% impairment of the whole person.
56
Figure 6-A: Steps for calculating impairment of the visual system
Determine and record the percentage loss of central vision for each eye separately, combining the losses of near and
Step 1
distance vision. Refer to Figure 6-C.
Determine and record the percentage loss of visual fields for each eye separately (monocular) or for both eyes together
Step 2
(binocular).
Using the combined values chart (see Appendix 1), combine the results from Step 1 and Step 2 for each eye if any
Step 3
central vision and visual field impairment is present.
Step 4 Determine and record the percentage loss of ocular motility.
Using the combined values chart (see Appendix 1), combine the result of Step 3 with Step 4 if there is any ocular
Step 5
motility impairment.
Step 6 Determine and record the percentage loss if other ocular impairments are present.
Using the combined values chart (see Appendix 1), combine the result of Step 5 with Step 6 if any other ocular
Step 7
impairment is present.
Determine the visual impairment for both eyes. The visual impairment for both eyes is calculated by the formula:
3 x (impairment of better eye) + (impairment of worse eye) = visual system
Step 8
4 impairment
Alternatively use Figure 6-F.
Step 9 Convert the visual impairment for both eyes to a WPI rating using Table 6.1 below.
Using the combined values chart (see Appendix 1), combine the result of Step 9 with any impairment (up to 10%
Step 10
maximum) arising from other conditions causing permanent deformities (see section 6.5).
57
Table 6.1: Conversion of the visual system to whole person impairment rating
Source: American Medical Association Guides to the Evaluation of Permanent Impairment (4th edition, 1995, Table 6, Chapter 8,
page 218).
Visual system Whole person Visual system Whole person Visual system Whole person Visual system Whole person
0 0
1 1 26 25 51 48 76 72
2 2 27 25 52 49 77 73
3 3 28 26 53 50 78 74
4 4 29 27 54 51 79 75
5 5 30 28 55 52 80 76
6 6 31 29 56 53 81 76
7 7 32 30 57 54 82 77
8 8 33 31 58 55 83 78
9 8 34 32 59 56 84 79
10 9 35 33 60 57 85 80
11 10 36 34 61 58 86 81
12 11 37 35 62 59 87 82
13 12 38 36 63 59 88 83
14 13 39 37 64 60 89 84
15 14 40 38 65 61 90 85
16 15 41 39 66 62 91 85
17 16 42 40 67 63 92 85
18 17 43 41 68 64 93 85
19 18 44 42 69 65 94 85
20 19 45 42 70 66 95 85
21 20 46 43 71 67 96 85
22 21 47 44 72 68 97 85
23 22 48 45 73 69 98 85
24 23 49 46 74 70 99 85
25 24 50 47 75 71 100 85
58
6.1 CENTRAL VISUAL ACUITY
A Snellen test chart is used to measure the distance of visual acuity. The test distance is six metres.
The near vision is measured using a LogMar reading card. If Near Snellen, Jaeger, Sloan or Roman reading cards are used the results
need to be converted to LogMar (see Figure 6-B over page). The distance in the near reading test is not fixed: the reading distance
should be recorded by the ophthalmologist.
Central vision should be tested and recorded for distant and near objects. The employee should be refracted and tested with loose
lenses, phoropter, or with his/her own glasses provided their correction is accurate.
If an employee wears contact lenses each day and wishes to wear them for the test, this is acceptable for measuring acuity. In certain
ocular conditions (particularly in the presence of corneal abnormalities) contact lens-corrected vision may be better than that obtained
with spectacle correction. However, if an employee does not already wear contact lenses, they should not be fitted for an impairment
assessment.
59
Figure 6-B: Revised LogMar equivalent for different reading cards
Equivalent to Revised Jaeger

LogMar Near Snellen N. Points Roman
Snellen standard
0.3 14/14 6/6 N5 3 1
0.4 14/18 6/7.5 N6 4 2
0.5 14/21 6/9 N7 5 3
0.6 14/24 6/12 N8 6 4
0.65 14/28 6/15 N9 7 5
0.7 14/35 6/18 N10 8 6
0.725 14/40 6/24 N12 9 7
0.75 14/45 6/30 N15 10 8
0.8 14/60 6/36 N17 11 9
0.9 14/70 6/48 N18 12 10
1.0 14/80 6/60 N20 13 11
1.1 14/88 6/90 N24 14 12
1.3 14/112 6/120 N40 21 13
1.6 14/140 6/240 N80 23 14
6.1.1 Determining the loss of central vision in one eye
The following steps are taken to determine loss of central vision in one eye.
Step 1 Measure the central acuity for distance and near, correcting for any refractive errors and presbyopia, and record the result.
Step 2 Consult Figure 6-C below to derive the overall loss, combining the values for corrected near and distance acuities.
If monocular aphakia or pseudoaphakia is present then add 50% to the percentage loss of Central Vision obtained from
Step 3
Figure 6-C.
60
Figure 6-C: Percentage loss of central vision in one eye
Distance vision Revised LogMar standard for near vision

(metric 6) 0.3 0.4 0.4 0.5 0.6 0.7 0.7 0.7 0.8 0.9 1.0 1.1 1.3 1.6
6/5 0 0 3 4 5 25 27 30 40 43 44 45 48 49
6/6 0 0 3 4 5 25 27 30 40 43 44 46 48 49
6/7.5 3 3 5 6 8 28 30 33 43 45 46 48 50 52
6/10 5 5 8 9 10 30 32 35 45 48 49 50 53 54
6/12 8 8 10 11 13 33 35 38 48 50 5 53 55 57
6/15 13 13 15 16 18 38 40 43 53 55 56 58 60 62
6/20 16 16 18 20 22 41 44 46 56 59 60 61 64 65
6/22 18 18 21 22 23 43 46 48 58 61 62 63 66 67
6/24 20 20 23 24 25 45 47 50 60 63 64 65 68 69
6/30 25 25 28 29 30 50 52 55 58 68 69 70 73 74
6/38 30 30 33 34 35 55 57 60 70 73 74 75 78 79
6/50 34 34 37 38 39 59 61 64 74 77 78 79 82 83
6/60 40 40 43 44 45 65 67 70 80 83 84 85 88 89
6/90 43 43 45 46 48 68 70 73 83 85 86 88 90 92
6/120 45 45 48 49 50 70 72 75 85 88 89 90 93 94
6/240 48 48 50 51 53 73 75 78 88 90 91 93 95 97
61
6.2 DETERMINING LOSS OF MONOCULAR VISUAL FIELDS Figure 6-D: Normal extent of the visual field
There are many ways of measuring the visual field. The most Direction of vision Degrees of field
common are the manual Goldman Field and the Humphrey,
Temporally 85
Octopus and Medmont computerised field analysers. If using
a computerised field it is necessary to test at least a 30-2 Down temporally 85
threshold.
Direct down 65
An Esterman Binocular Field is suitable for the majority of Down nasally 50
visual field impairment assessments. The field is tested with
Nasally 60
the employee wearing their spectacles and both eyes open. The
binocular field result is determined by using the Esterman 120- Up nasally 55
unit binocular grid, and the dot count is multiplied by 5/6 to Direct up 45
obtain the percentage of retained or lost field. Note that binocular
Up temporally 55
field-testing is not recommended when diplopia is present.
Total 500
If the automated 30-2 Threshold Field is normal, and the ocular
history and examination do not suggest lesions that would affect
the outer part of the field, it is acceptable to conclude that the
entire field is normal. Whatever technique is used to measure the
visual field, the test should be performed by an ophthalmologist.
The normal visual field meridians in each of eight principal

meridians are given in Figure 6-D. The total, summed over 8
meridians is 500.
62
The percentage of retained vision is calculated using the If the diplopia is not within the central 20º, the presence of
following steps. diplopia is then plotted along the 8 meridians (see Figure 6-E
below). The largest percentage on any of the meridians in which
Add the extent of the visual field along each of there is double vision is the impairment percentage for loss of
the 8 meridians (while considering the maximum ocular motility.
Step 1
normal values for the meridians given in Figure
6-D).
Figure 6-E: Percentage loss of ocular motility of one eye in
Divide by 5 to determine the percentage of visual diplopia fields
Step 2
field perception that remains.
Adapted from American Medical Association’s Guides to the
To obtain the percentage of visual field loss,
Step 3 subtract the percentage of visual field remaining Evaluation of Permanent Impairment, 4th edition, 1995,
from 100%. Chapter 8, page 217.
These steps are based upon the following formulae:

30
Total visual field = % of remaining visual field 10
20
5
10% 10 10%
100 – (% of remaining visual field) = % of visual field lost 10% 10%
20 10 20%
6.3 ABNORMAL OCULAR MOTILITY AND BINOCULAR 10 10%
DIPLOPIA 20 20 20
Diplopia within the central 30° is measured by an 10% 30 10

ophthalmologist with a tangent screen. Unless there is diplopia Key:
40
within 30° of the centre of fixation, the diplopia does not cause Equals 50%
significant visual impairment. The exception is when looking
downwards. Double vision within the central 20° signifies the
maximum loss of ocular motility (that is, a 50% loss of ocular
motility in one eye).
63
6.4 OTHER OCULAR ABNORMALITIES 6.6 CALCULATION OF VISUAL SYSTEM IMPAIRMENT FOR
BOTH EYES
If an ocular adnexal disturbance or deformity interferes with
visual function and is not reflected in diminished visual acuity, Figure 6-F (from the American Medical Association’s Guides to
decreased visual fields, or ocular motility abnormalities with the Evaluation of Permanent Impairment, Chapter 8, page 219,
diplopia, then the significance of the disturbance or deformity 4th edition, 1995) is on the three following pages.
should be evaluated by an examining ophthalmologist. In that
Figure 6-F was established using the equation:
situation, using the combined values chart (see Appendix 1),
the ophthalmologist may combine up to an additional 10% 3 x (impairment value of better eye)
impairment for each affected eye. + (impairment value of worse eye) = impairment of
visual system
Problems in the visual system should also be taken into account
4
where they result in symptoms such as epiphora, photophobia,
metamorphopsia, and convergence insufficiency. Percentages for the worse eye are read from the side of the table.
Percentages for the better eye are read from the bottom of the
6.5 OTHER CONDITIONS INVOLVING PERMANENT
table.
DEFORMITIES CAUSING UP TO 10% IMPAIRMENT OF THE
WHOLE PERSON The impairment of the visual system is at the intersection of the
column for the worse eye and the row for the better eye.
Using the combined values chart (see Appendix 1), an
additional WPI of up to 10% may be combined with WPI ratings For example, for a 40% impairment of one eye and 10%
for conditions such as permanent deformities of the orbit, scars, impairment of the other eye, read down the table until you
and other cosmetic deformities that do not otherwise alter ocular come to the large value (40%). Follow across the row until it is
function. intersected with the column designated by 10% at the bottom of
the page (18%). Thus, the impairment to the visual system is
18%.
Figure 6-F: Calculation of Visual System Impairment for Both Eyes
0 0
1 0 1
2 1 1 2
3 1 2 2 3
4 1 2 3 3 4
5 1 2 3 4 4 5
6 2 2 3 4 5 5 6
7 2 3 3 4 5 6 6 7
8 2 3 4 4 5 6 7 7 8
9 2 3 4 5 5 6 7 8 8 9
10 3 3 4 5 6 6 7 8 9 9 10
11 3 4 4 5 6 7 7 8 9 10 10 11
12 3 4 5 5 6 7 8 8 9 10 11 11 12
13 3 4 5 6 6 7 8 9 9 10 11 12 12 13
14 4 4 5 6 7 7 8 9 10 10 11 12 13 13 14
15 4 5 5 6 7 8 8 9 10 11 11 12 13 14 14 15
16 4 5 6 6 7 8 9 9 10 11 12 12 13 14 15 15 16
17 4 5 6 7 7 8 9 10 10 11 12 13 13 14 15 16 16 17
18 5 5 6 7 8 8 9 10 11 11 12 13 14 14 15 16 17 17 18
19 5 6 6 7 8 9 9 10 11 12 12 13 14 15 15 16 17 18 18 19
20 5 6 7 7 8 9 10 10 11 12 13 13 14 15 16 16 17 18 19 19 20
21 5 6 7 8 8 9 10 11 11 12 13 14 14 15 16 17 17 18 19 20 20 21
22 6 6 7 8 9 9 10 11 12 12 13 14 15 15 16 17 18 18 19 20 21 21 22
23 6 7 7 8 9 10 10 11 12 13 13 14 15 16 16 17 18 19 19 20 21 22 22 23
24 6 7 8 8 9 10 11 11 12 13 14 14 15 16 17 17 18 19 20 20 21 22 23 23 24
25 6 7 8 9 9 10 11 12 12 13 14 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25
26 7 7 8 9 10 10 11 12 13 13 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26
27 7 8 8 9 10 11 11 12 13 14 14 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27
28 7 8 9 9 10 11 12 12 13 14 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28
% Impairment worse eye

29 7 8 9 10 10 11 12 13 13 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29
30 8 8 9 10 11 11 12 13 14 14 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30
31 8 9 9 10 11 12 12 13 14 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31
32 8 9 10 10 11 12 13 13 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32
33 8 9 10 11 11 12 13 14 14 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33
34 9 9 10 11 12 12 13 14 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34
35 9 10 10 11 12 13 13 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35
36 9 10 11 11 12 13 14 14 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36
37 9 10 11 12 12 13 14 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37
38 10 10 11 12 13 13 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38
39 10 11 11 12 13 14 14 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39
40 10 11 12 12 13 14 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40
41 10 11 12 13 13 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41
42 11 11 12 13 14 14 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42
43 11 12 12 13 14 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43
44 11 12 13 13 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44
45 11 12 13 14 14 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45
46 12 12 13 14 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46
47 12 13 13 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47
48 12 13 14 14 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48
49 12 13 14 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49
% Impairment better eye
Figure 6-F: Calculation of visual system impairment for both eyes (continued)
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49
50 13 13 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49
51 13 14 14 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50
52 13 14 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50
53 13 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50
54 14 14 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50
55 14 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51
56 14 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51
57 14 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51
58 15 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51
59 15 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52
60 15 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52
61 15 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52
62 16 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52
63 16 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53
64 16 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53
65 16 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53
66 17 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53
67 17 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54
68 17 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53 54
69 17 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53 54
70 18 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54 54
71 18 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53 54 55
72 18 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53 54 55
73 18 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54 54 55
74 19 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53 54 55 55
75 19 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53 54 55 56
76 19 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54 54 55 56
77 19 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53 54 55 55 56
78 20 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53 54 55 56 56

79 20 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54 54 55 56 57
80 20 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53 54 55 55 56 57
81 20 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53 54 55 56 56 57
82 21 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54 54 55 56 57 57
83 21 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53 54 55 55 56 57 58
84 21 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53 54 55 56 56 57 58
85 21 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54 54 55 56 57 57 58
86 22 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53 54 55 55 56 57 58 58
87 22 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53 54 55 56 56 57 58 59
88 22 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54 54 55 56 57 57 58 59
89 22 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53 54 55 55 56 57 58 58 59
90 23 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53 54 55 56 56 57 58 59 59
91 23 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54 54 55 56 57 57 58 59 60
92 23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53 54 55 55 56 57 58 58 59 60
93 23 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53 54 55 56 56 57 58 59 59 60
94 24 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54 54 55 56 57 57 58 59 60 60
95 24 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53 54 55 55 56 57 58 58 59 60 61
96 24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53 54 55 56 56 57 58 59 59 60 61
97 24 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54 54 55 56 57 57 58 59 60 60 61
98 25 25 26 27 28 28 29 30 31 31 32 33 34 34 35 36 37 37 38 39 40 40 41 42 43 43 44 45 46 46 47 48 49 49 50 51 52 52 53 54 55 55 56 57 58 58 59 60 61 61
99 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42 43 44 44 45 46 47 47 48 49 50 50 51 52 53 53 54 55 56 56 57 58 59 59 60 61 62
100 25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47 48 48 49 50 51 51 52 53 54 54 55 56 57 57 58 59 60 60 61 62
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49

50 50
51 50 51
52 51 51 52
53 51 52 52 53
54 51 52 53 53 54
55 51 52 53 54 54 55
56 52 52 53 54 55 55 56
57 52 53 53 54 55 56 56 57
58 52 53 54 54 55 56 57 57 58
59 52 53 54 55 55 56 57 58 58 59
60 53 53 54 55 56 56 57 58 59 59 60
61 53 54 54 55 56 57 57 58 59 60 60 61
62 53 54 55 55 56 57 58 58 59 60 61 61 62
63 53 54 55 56 56 57 58 59 59 60 61 62 62 63
64 54 54 55 56 57 57 58 59 60 60 61 62 63 63 64
65 54 55 55 56 57 58 58 59 60 61 61 62 63 64 64 65
66 54 55 56 56 57 58 59 59 60 61 62 62 63 64 65 65 66
67 54 55 56 57 57 58 59 60 60 61 62 63 63 64 65 66 66 67
68 55 55 56 57 58 58 59 60 61 61 62 63 64 64 65 66 67 67 68
69 55 56 56 57 58 59 59 60 61 62 62 63 64 65 65 66 67 68 68 69
70 55 56 57 57 58 59 60 60 61 62 63 63 64 65 66 66 67 68 69 69 70
71 55 56 57 58 58 59 60 61 61 62 63 64 64 65 66 67 67 68 69 70 70 71
72 56 56 57 58 59 59 60 61 62 62 63 64 65 65 66 67 68 68 69 70 71 71 72
73 56 57 57 58 59 60 60 61 62 63 63 64 65 66 66 67 68 69 69 70 71 72 72 73
74 56 57 58 58 59 60 61 61 62 63 64 64 65 66 67 67 68 69 70 70 71 72 73 73 74
75 56 57 58 59 59 60 61 62 62 63 64 65 65 66 67 68 68 69 70 71 71 72 73 74 74 75
76 57 57 58 59 60 60 61 62 63 63 64 65 66 66 67 68 69 69 70 71 72 72 73 74 75 75 76
77 57 58 58 59 60 61 61 62 63 64 64 65 66 67 67 68 69 70 70 71 72 73 73 74 75 76 76 77
78 57 58 59 59 60 61 62 62 63 64 65 65 66 67 68 68 69 70 71 71 72 73 74 74 75 76 77 77 78
79 57 58 59 60 60 61 62 63 63 64 65 66 66 67 68 69 69 70 71 72 72 73 74 75 75 76 77 78 78 79

80 58 58 59 60 61 61 62 63 64 64 65 66 67 67 68 69 70 70 71 72 73 73 74 75 76 76 77 78 79 79 80
81 58 59 59 60 61 62 62 63 64 65 65 66 67 68 68 69 70 71 71 72 73 74 74 75 76 77 77 78 79 80 80 81
82 58 59 60 60 61 62 63 63 64 65 66 66 67 68 69 69 70 71 72 72 73 74 75 75 76 77 78 78 79 80 81 81 82
83 58 59 60 61 61 62 63 64 64 65 66 67 67 68 69 70 70 71 72 73 73 74 75 76 76 77 78 79 79 80 81 82 82 83
84 59 59 60 61 62 62 63 64 65 65 66 67 68 68 69 70 71 71 72 73 74 74 75 76 77 77 78 79 80 80 81 82 83 83 84
85 59 60 60 61 62 63 63 64 65 66 66 67 68 69 69 70 71 72 72 73 74 75 75 76 77 78 78 79 80 81 81 82 83 84 84 85
86 59 60 61 61 62 63 64 64 65 66 67 67 68 69 70 70 71 72 73 73 74 75 76 76 77 78 79 79 80 81 82 82 83 84 85 85 86
87 59 60 61 62 62 63 64 65 65 66 67 68 68 69 70 71 71 72 73 74 74 75 76 77 77 78 79 80 80 81 82 83 83 84 85 86 86 87
88 60 60 61 62 63 63 64 65 66 66 67 68 69 69 70 71 72 72 73 74 75 75 76 77 78 78 79 80 81 81 82 83 84 84 85 86 87 87 88
89 60 61 61 62 63 64 64 65 66 67 67 68 69 70 70 71 72 73 73 74 75 76 76 77 78 79 79 80 81 82 82 83 84 85 85 86 87 88 88 89
90 60 61 62 62 63 64 65 65 66 67 68 68 69 70 71 71 72 73 74 74 75 76 77 77 78 79 80 80 81 82 83 83 84 85 86 86 87 88 89 89 90
91 60 61 62 63 63 64 65 66 66 67 68 69 69 70 71 72 72 73 74 75 75 76 77 78 78 79 80 81 81 82 83 84 84 85 86 87 87 88 89 90 90 91
92 61 61 62 63 64 64 65 66 67 67 68 69 70 70 71 72 73 73 74 75 76 76 77 78 79 79 80 81 82 82 83 84 85 85 86 87 88 88 89 90 91 91 92
93 61 62 62 63 64 65 65 66 67 68 68 69 70 71 71 72 73 74 74 75 76 77 77 78 79 80 80 81 82 83 83 84 85 86 86 87 88 89 89 90 91 92 92 93
94 61 62 63 63 64 65 66 66 67 68 69 69 70 71 72 72 73 74 75 75 76 77 78 78 79 80 81 81 82 83 84 84 85 86 87 87 88 89 90 90 91 92 93 93 94
95 61 62 63 64 64 65 66 67 67 68 69 70 70 71 72 73 73 74 75 76 76 77 78 79 79 80 81 82 82 83 84 85 85 86 87 88 88 89 90 91 91 92 93 94 94 95
96 62 62 63 64 65 65 66 67 68 68 69 70 71 71 72 73 74 74 75 76 77 77 78 79 80 80 81 82 83 83 84 85 86 86 87 88 89 89 90 91 92 92 93 94 95 95 96
97 62 63 63 64 65 66 66 67 68 69 69 70 71 72 72 73 74 75 75 76 77 78 78 79 80 81 81 82 83 84 84 85 86 87 87 88 89 90 90 91 92 93 93 94 95 96 96 97
98 62 63 64 64 65 66 67 67 68 69 70 70 71 72 73 73 74 75 76 76 77 78 79 79 80 81 82 82 83 84 85 85 86 87 88 88 89 90 91 91 92 93 94 94 95 96 97 97 98
99 62 63 64 65 65 66 67 68 68 69 70 71 71 72 73 74 74 75 76 77 77 78 79 80 80 81 82 83 83 84 85 86 86 87 88 89 89 90 91 92 92 93 94 95 95 96 97 98 98 99
100 63 63 64 65 66 66 67 68 69 69 70 71 72 72 73 74 75 75 76 77 78 78 79 80 81 81 82 83 84 84 85 86 87 87 88 89 90 90 91 92 93 93 94 95 96 96 97 98 99 99 100
50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100

67
CHAPTER 7—EAR, NOSE AND THROAT DISORDERS
7.0 INTRODUCTION 68
7.1 HEARING LOSS 68
7.2 TINNITUS 68
7.3 OLFACTION AND TASTE 69
7.4 SPEECH 69
7.5 AIR PASSAGE DEFECTS 70
7.6 NASAL PASSAGE DEFECTS 72
7.7 CHEWING AND SWALLOWING 72
68
7.0 INTRODUCTION 7.1 HEARING LOSS
In conducting an assessment, the assessor must have regard Hearing defects are assessed in accordance with the current
to the principles of assessment (see pages 9-13) and the procedures from Australian Hearing.
Once the binaural percentage loss of hearing has been
Table 12.5.5: The auditory nerve (see Chapter 12—The calculated, it is then converted to a WPI rating.
neurological system) should be used to assess both Menière’s
The calculation for converting the percentage loss of hearing to a
disease, and true vertigo consequent upon a disturbance of
WPI rating is:
vestibular function.
(Percentage Loss of Hearing)
Unless they cause interference with balance, speech, respiration
or hearing, the following conditions attract a WPI rating of 0: 2
> rhinitis
7.2 TINNITUS
> sinusitis
> laryngitis Table 7.2 is used to assess impairment arising as a result of
tinnitus in the presence of unilateral or bilateral hearing loss.
> pharyngitis
> otitis media or externa (whether permanent or intermittent). Table 7.2: Tinnitus
If interference with balance, speech, respiration or hearing is % WPI Criteria

present, these conditions attract WPI ratings based on the degree
of interference with balance, speech, respiration or hearing as Continuous tinnitus which has nuisance value but
0 can be forgotten or ignored with background noise
described in the tables in Chapter 7.
or a low level noise generator.
Severe continuous tinnitus which causes extreme
5 distress, interferes with concentration and is not
assisted by a low level noise generator.
69
7.3 OLFACTION AND TASTE Table 7.4 must not be used to assess speech impairment
resulting from a lesion of the central nervous system. In such
Only complete loss of olfaction or taste attracts a WPI rating. If
cases, assessment should be made under Table 12.3.2:
the employee is able to detect any odour or taste, even if unable
Production of speech and language symbols (see Chapter 12—
to identify it, the WPI rating is 0.
The neurological system).
WPI ratings from this table may not be combined with WPI
WPI ratings from Table 7.4 may not be combined with WPI
ratings for the same condition from either Table 12.5.1:
ratings from Table 12.3.2: Production of speech and language
Olfactory Nerve (see Chapter 12—The neurological system), or
symbols (see Chapter 12—The neurological system).
Table 12.5.4: Facial nerve (see Chapter 12—The neurological
system). If there are two separate conditions (one local, and the other
a central nervous system condition) interfering with speech
Table 7.3: Olfaction and taste production, speech production should be assessed under both
Table 7.4 and Table 12.3.2. The greater value is the WPI rating
% WPI Criterion due to speech impairment from all causes.
Complete loss of olfaction WPI ratings from within Table 7.4 may not be combined with
5 or each other.
Complete loss of taste.
If the major problem is one of audibility, intelligibility, or
Complete loss of olfaction
functional efficiency of speech, the criteria appropriate to the
10 and
area should be used to assess impairment.
Complete loss of taste.
If there are problems in more than one area, each area
(audibility, intelligibility, and functional efficiency) should be
7.4 SPEECH
assessed, and the highest value selected as the WPI rating.
Table 7.4 over page is used to assess impairment resulting
from interference with speech from local lesions of the organs of
speech.
For the purposes of Table 7.4, ‘speech’ means the capacity

to produce vocal signals that can be heard, understood, and
sustained over a useful period of time.
70
Table 7.4: Speech
Criteria
% WPI
Audibility Intelligibility Functional efficiency
Generally intelligible, although
Audible in most situations, although Speech can be sustained except for
0 some sounds are difficult and some
may require effort. slowness and some hesitancy.
repetition may be needed.
Audible in quiet situations but Intelligible although inaccuracies Speech can be sustained but is often
10 problems with audibility in noisy may be frequent and there are discontinuous, interrupted, hesitant
environments. obvious difficulties with articulation. and/or slow.
Voice tires rapidly, tends to become Intelligible to family and close friends Difficulty sustaining speech for
15 inaudible after a few seconds. but strangers find speech generally more than brief periods even when
Volume generally low. unintelligible even with repetition. speaking very slowly.
Volume very low.

Laboured speech.
Can whisper or produce volume that Mostly unintelligible, except for a few
20 Rate of sustained speech
can be heard only with difficulty by words.
impractically slow.
close listener or by telephone.
30 Inaudible. Unintelligible. No sustained speech.
7.5 AIR PASSAGE DEFECTS
Table 7.5 assesses permanent impairment relating to defects of the air passages. Impairments of the lower airways and lung
parenchyma, are dealt with in Chapter 2—Respiratory system.
Permanent tracheostomy, or other respiratory stoma, attracts a permanent WPI rating of 25% which may be combined with other
values derived from Table 7.5.
An employee is placed in an impairment category based on the criteria in Table 7.5 over page.
71
Table 7.5 applies only to permanent partial obstruction of one or more of the following structures:
> oropharnyx
> laryngopharynx
> larynx
> trachea.
Table 7.5 does not apply to nasal obstruction. Nasal obstruction is assessed under Table 7.6: Nasal passage defects (see over
page).
Prophylactic restriction of activity, such as sporting activity, does not attract the same WPI rating as dyspnoea on participation in the
activity.
Table 7.5: Air passage defects
% WPI
Criteria
0 10 30 40 50 70 90
Ventilation required No No No No No No Yes
Not
Dyspnoea at rest No No No No Yes Yes (severe)
applicable
Dyspnoea with
Not Not
dressing or No No No Yes Yes (severe)
applicable applicable
grooming
Dyspnoea with
Not Not Not Not
walking 200m or No No Yes
applicable applicable applicable applicable
climbing eight steps
Dyspnoea with
hurrying, hill Not Not Not Not Not
No Yes
climbing or sporting applicable applicable applicable applicable applicable
activity
72
glossopharyngeal, vagus, spinal accessory and hypoglossal
nerves (see Chapter 12—The neurological system).
7.6 NASAL PASSAGE DEFECTS
Table 7.7: Chewing and swallowing
Table 7.6 applies only to nasal obstruction.
% WPI Criteria
Table 7.6: Nasal passage defects
No interference. Food of any desired type may be
0
eaten without difficulty.
% WPI Criterion
Very tough or hard food has to be avoided but diet
Continuous nasal obstruction of sufficient severity 2
3 is otherwise as desired.
to cause mouth breathing at rest.
5 Diet is limited to soft foods.
7.7 CHEWING AND SWALLOWING 10 Diet is limited to pureed foods.

20 Diet is limited to liquid foods.
Table 7.7 is used to assess impairment resulting from facial
muscle damage or loss, dental and oral problems, and No oral ingestion of food or fluid is possible. Food
temporomandibular joint dysfunction. 40 can only be ingested by means of a nasogastric,
gastrostomy, oesophagostomy or other tube.
WPI ratings derived from Table 7.7 may be combined with WPI
ratings derived from Table 8.4: Surgically created stomas (see
Chapter 8—The digestive system).
For the same condition, WPI ratings derived from Table 7.7
may not be combined with WPI ratings from Table 12.5.6: The
73
CHAPTER 8—THE DIGESTIVE SYSTEM
8.0 INTRODUCTION 74
8.1 UPPER DIGESTIVE TRACT—OESOPHAGUS, STOMACH, DUODENUM, SMALL INTESTINE
AND PANCREAS 76
8.2 LOWER GASTROINTESTINAL TRACT—COLON AND RECTUM 78
8.3 LOWER GASTROINTESTINAL TRACT—ANUS 81
8.4 SURGICALLY CREATED STOMAS 82
8.5 LIVER—CHRONIC HEPATITIS AND PARENCHYMAL LIVER DISEASE 83
8.6 BILIARY TRACT 85
8.7 HERNIAS OF THE ABDOMINAL WALL 86
74
8.0 INTRODUCTION Figure 8-A: Activities of daily living
In conducting an assessment, the assessor must have regard Activity Examples

Self care, personal Bathing, grooming, dressing, eating,
hygiene eliminating.
‘Activities of daily living’ are activities which an employee needs Hearing, speaking, reading, writing,
to perform to function in a non-specific environment (that is, to Communication
using keyboard.
live). Performance of activities of daily living is measured by
Standing, sitting, reclining, walking,
reference to primary biological and psychosocial function. stooping, squatting, kneeling, reaching,
Physical activity bending, twisting, leaning, carrying,
For the purposes of Chapter 8, activities of daily living are those
lifting, pulling, pushing, climbing,
in Figure 8-A. exercising.
Grasping, holding, pinching, percussive
Hand functions
movements, sensory discrimination.
Social and Participating in individual or group
recreational activities, sports activities, hobbies.
Tables 8.1, 8.2 and 8.3 refer to primary and secondary criteria.
All criteria from both categories (except where otherwise
stipulated) must be met before a WPI rating can be assigned.
75
Where the condition being assessed interferes with chewing Figure 8-B: Body Mass Index criteria
and/or swallowing, assessment is made under whichever of the
following tables describes the impairment more specifically: BMI Category Health risk
> Table 7.7: Chewing and swallowing (see Chapter 7—Ear, <18 Very underweight Long-term hazard to health.
nose and throat disorders) 18-20 Underweight Low risk to health.
> Table 12.5.6: The glossopharyngeal, vagus, spinal Least risk for morbidity and
accessory and hypoglossal nerves (see Chapter 12—The 20-25 Acceptable
minimal mortality.
neurological system).
25-30 Overweight Low risk to health.
For the same condition, WPI ratings derived from Table 12.5.6 30-40 Morbid obesity High degree of risk to health.
may not be combined with WPI ratings derived from Table 7.7.
Other complications of bleeding disorders assessed under

Table 13.3: Haemorrhagic disorders and platelet disorders
(see Chapter 13—The haematopoietic system) may also be
assessed under tables in Chapter 8, according to the site of the
blood loss. The WPI rating so obtained should be combined
with the WPI rating obtained from Table 13.3.
Where applicable, Body Mass Index (BMI) values are used

as the objective assessment for weight. See Figure 8-B for
calculation of BMI values.
Calculation of Body Mass Index (BMI)
Body Mass Index (BMI) is calculated as follows:
Weight (kg)
Height2 (m)
The value obtained should be rounded to the nearest whole

number.
76
8.1 UPPER DIGESTIVE TRACT—OESOPHAGUS, STOMACH, DUODENUM, SMALL INTESTINE AND PANCREAS
Table 8.1: Upper digestive tract—oesophagus, stomach, duodenum, small intestine and pancreas
% WPI Primary criteria Secondary criteria

Symptoms of upper digestive tract
0 disease with or without anatomical loss Continuous drug treatment not required to control symptoms.
or pathological alteration present.
> Continuous drug treatment required to control symptoms, signs or
10 disease, with anatomical loss or
nutritional deficiency
pathological alteration present.
> Appropriate dietary modifications required to control symptoms or signs.
Both of the following:
> Continuous drug treatment required to control symptoms, signs or
nutritional deficiency
pathological alteration present.
> Appropriate dietary modifications required to control symptoms or signs.
Any one of the following:
> Continuous drug treatment does not completely control symptoms, signs
Symptoms of upper digestive tract or nutritional deficiency
pathological alteration present. > Appropriate dietary modifications do not completely control symptoms,
signs or nutritional deficiency
> Weight loss with a BMI<20.
Any two of the following:
> Continuous drug treatment does not completely control symptoms, signs
Symptoms of upper digestive tract or nutritional deficiency
Table 8.1 continued on following page.

77

All of the following:
> Continuous drug treatment does not completely control symptoms,
Symptoms of upper digestive tract signs or nutritional deficiency
> Continuous drug treatment has little effect on symptoms, signs or
Symptoms of upper digestive tract nutritional deficiency
60 disease, with anatomical loss or > Appropriate dietary modifications have little effect on symptoms, signs
pathological alteration present. or nutritional deficiency
> Assistance required with most or all activities of daily living
Symptoms of upper digestive tract > Severe impairment of nutritional status uncontrolled by any treatment or
70 disease, with anatomical loss or dietary modifications
pathological alteration present. > Assistance required with all activities of daily living
Notes to Table 8.1
1. Continuous drug treatment includes H2 receptor antagonists, proton pump inhibitors, corticosteroids, and pancreatic enzyme
supplementation.
2. Continuous drug treatment does not include antacids, or mixed antacid and alginic acid preparations.
3. Modified diet does not include the avoidance of a few, or selected, food items. It refers to special diets devised to manage
symptoms of the disease and maximise nutrition (for example, lactose-free diet, gluten-free diet).
78
8.2 LOWER GASTROINTESTINAL TRACT—COLON AND RECTUM
Table 8.2: Lower gastrointestinal tract—colon and rectum
See notes to Table 8.2 on page 80.

No requirement for any of the following as short term treatment:
> Limitation of activities of daily living
Signs and/or symptoms of colonic or > Modified diet
0 rectal disease occur infrequently, and/or
are of brief duration. > Medication.
No systemic manifestations.
Weight and nutrition can be maintained at desirable levels.
Generally no requirement for any of the following as long-term treatment to
control disease although may be needed short term:
Signs and/or symptoms of colonic or > Limitation of activities of daily living
10 rectal disease occur more frequently, and/ > Modified diet
or are of longer duration. > Medication.
Requirement for at least one of the following as long-term treatment to
control disease:
Objective evidence of colonic or rectal > Modified diet
20
disease, with anatomic loss or alteration.
> Medication.

79

Requirement for all of the following as long-term treatment to control
disease:
Objective evidence of colonic or rectal > Limitation of activities of daily living
30 disease, with anatomical loss or > Modified diet
alteration. > Medication.
Weight and nutrition can be maintained at desirable level.
disease:
> Medication.
alteration.
Presence of one of the following:
> Systemic manifestations (for example, fever, anaemia)
disease:
> Medication.
alteration.
Presence of both of the following:

80

None of the following long-term treatments control the disease:
> Modified diet
Objective evidence of colonic or rectal > Medication.
60 disease, with anatomical loss or Presence of at least one of the following:
alteration. > Limitation of Activities of Daily Living
None of the following long-term treatments control the disease:
> Modified diet
Objective evidence of colonic or rectal > Medication.
70 disease, with anatomical loss or Presence of all of the following:
alteration. > Systemic manifestations (for example, fever, anaemia)
> Assistance required with activities of daily living
Notes to Table 8.2
1. Medication does not include fibre supplements, vitamins or other nutritional supplements (unless there is a demonstrated
vitamin deficiency), or over the counter preparations.
2. Modified diet does not include the avoidance of a few, or selected, food items. It refers to special diets devised to manage the
symptoms of the disease and maximise nutrition (for example, lactose free diet, gluten free diet).
81
8.3 LOWER GASTROINTESTINAL TRACT—ANUS
Where the anal disorder is part of a colo-rectal disorder (for example, Crohn’s Disease), WPI ratings from Tables 8.2: Lower
gastrointestinal tract—colon and rectum (see page 78) and Table 8.3 may be combined using the combined values chart (see
Appendix 1).
Table 8.3: Lower gastrointestinal tract—anus

Signs of organic anal disease are absent
Incontinence of flatus, or other mild or intermittent anal symptoms which
0 or
can be controlled by treatment.
There is no anatomical loss or alteration.
Mild incontinence of flatus
Signs of organic anal disease are present
and/or
or
10 Mild incontinence of liquid stool
There is anatomical loss or alteration.
and
Mild or intermittent anal symptoms controlled by treatment.
Signs of organic anal disease are present Moderate daily faecal incontinence requiring treatment
20 or or
There is anatomical loss or alteration. Continual anal symptoms incompletely controlled by treatment.
Signs of organic anal disease are present Moderate daily faecal incontinence requiring treatment
30 or and
There is anatomical loss or alteration. Continual anal symptoms incompletely controlled by treatment.
Total faecal incontinence despite treatment
Signs of organic anal disease are present
or
40 and
Signs of organic anal disease with severe symptoms unresponsive or not
There is anatomical loss or alteration.
amenable to treatment.
82
8.4 SURGICALLY CREATED STOMAS
Using the combined values chart (see Appendix 1), WPI ratings
obtained from Table 8.4 may be combined with WPI ratings
from other digestive system tables in Chapter 8, and with WPI
ratings from Table 7.7: Chewing and swallowing (see page 72,
Chapter 7—Ear, nose and throat disorders).
Table 8.4: Surgically created stomas
See note to Table 8.4 immediately following the table.
% WPI Criteria
10 Colostomy.
Ileostomy.
15
Ileal pouch-anal anastomosis.
Jejunostomy.
20 Gastrostomy.
Oesophagostomy.
Note to Table 8.4
1. Assessment for surgically created stomas is only allowed

when the stoma is permanent and not a defunctioning or
temporary stoma.
83
8.5 LIVER—CHRONIC HEPATITIS AND PARENCHYMAL LIVER DISEASE
Table 8.5: Chronic hepatitis and parenchymal liver disease

Liver function tests may be normal or mildly abnormal.
Evidence of persistent or intermittent liver
disease. No history of jaundice, ascites or bleeding oesophageal varices in the last
0
three years.
Histological severity—very mild.
Adequate nutritional state.
Biochemistry abnormal.
Evidence of persistent liver disease. No history of jaundice, ascites or bleeding oesophageal varices in the last
10 - 15
Histological severity—mild. three years.
Adequate nutritional state.
Evidence of chronic liver disease. History of jaundice, ascites or bleeding oesophageal varices in the last 12
30
Histological severity—moderate. months.
Adequate nutritional state
Evidence of progressive, chronic liver History of jaundice, ascites or bleeding oesophageal varices in the last 12
40 disease. months.
Histological severity—severe. Adequate nutritional state.
Easily fatigued.
Evidence of progressive, chronic liver
History of jaundice, ascites, and/or bleeding oesophageal varices, in the
disease.
50 last 12 months.
Histological severity—chronic hepatitis
Nutritional state adversely affected.
with cirrhosis.
Fatigue and physical weakness.

84
Evidence of progressive chronic liver Biochemistry abnormal.

disease. History of jaundice, ascites and/or bleeding oesophageal varices in the
65 Histological severity—chronic hepatitis last 12 months.
with cirrhosis. Nutritional state adversely affected.
Persistent signs of hepatic insufficiency. Profound fatigue and physical weakness.
Evidence of advanced, irreparable Biochemistry abnormal.

chronic liver disease. History of jaundice, ascites and/or bleeding oesophageal varices in the
Histological severity—chronic hepatitis last 12 months.
75
with cirrhosis. Nutritional state adversely affected.
Persistent signs of advanced hepatic Profound fatigue and physical weakness.
insufficiency. Assistance required with activities of daily living.
Notes to Table 8.5
1. Signs of liver disease include: the stigmata of liver disease (spider angiomata, palmarerythema, and gynaecomastia);
jaundice; palpably enlarged liver; evidence of abnormal liver size on ultrasound; evidence of intrahepatic lesions on ultrasound
or positive antibodies to any of the viruses known to have the potential to cause chronic liver disease.
2. Jaundice does not include a mild elevation of plasma bilirubin with normal liver enzymes.
3. Liver function tests include estimates of total bilirubin, albumin, alkaline phosphatase (ALP), aspartate transaminase (AST),
alanine transaminase (ALT), and gamma glutamyl transferase (GGT).
4. All the criteria, both major and minor, must be present before a particular WPI rating can be allocated. However, liver biopsy is
not mandatory and should not be undertaken solely for the purpose of permanent impairment assessment.
5. Where liver biopsy has not been undertaken the histological criteria may be disregarded.
6. Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.
85
8.6 BILIARY TRACT
Table 8.6: Biliary tract
% WPI Criteria
0 Cholecystectomy with no biliary tract sequelae.
History of biliary type pain without identifiable biliary disease
10 or
Documented history of one to three episodes of biliary colic per year with identifiable biliary disease.
20 Documented history of four to six episodes of biliary colic per year with identifiable biliary disease.
30 Documented history of more than six episodes of biliary colic per year with identifiable biliary disease.
40 Permanent irreparable obstruction of the hepatic or common bile duct with recurrent cholangitis or permanent stent.
Permanent common bile duct obstruction with progressive liver disease manifest as persistent jaundice with
50
intermittent hepatic insufficiency.
Permanent common bile duct obstruction with progressive liver disease manifest as persistent jaundice and hepatic
65
insufficiency.
Permanent and irreparable common bile duct obstruction with advanced liver disease manifest as persistent jaundice
75
and hepatic insufficiency.
Note to Table 8.6
1. Biliary tract dysfunction should only be assessed after cholecystectomy or other appropriate biliary tract surgery, except where
there are sound medical reasons for not undertaking surgery.
86
8.7 HERNIAS OF THE ABDOMINAL WALL
Table 8.7: Hernias of the abdominal wall
% WPI Criteria
Abdominal wall defect with slight protrusion of abdominal contents palpable with increased abdominal pressure,
5
readily reducible.
Palpable abdominal wall defect with frequent or persistent protrusion of abdominal contents with increased abdominal
10
pressure, manually reducible.
Palpable abdominal wall defect with persistent, irreducible or irreparable protrusion of abdominal contents at the site of
25
defect, causing limitation of activities of daily living.
Note to Table 8.7
1. Hernias should be assessed only after surgical repair, except where there are sound medical reasons for repair not being
undertaken.
87
CHAPTER 9—THE MUSCULOSKELETAL SYSTEM
9.0 Introduction 88
PART I—THE LOWER EXTREMITIES—FEET AND TOES, ANKLES, KNEES AND HIPS 91
Part I—Introduction 91
9.1 Feet and toes 92
9.2 Ankles 95
9.3 Knees 97
9.4 Hips 99
9.5 Lower extremity amputations 101
9.6 Spinal nerve root impairments and peripheral nerve injuries affecting the lower extremities 103
9.7 Lower extremity function 106
PART II—THE UPPER EXTREMITIES: HANDS AND FINGERS, WRISTS, ELBOWS AND SHOULDERS 110
Part II—Introduction 110
9.8 Hands and fingers 111
9.9 Wrists 121
9.10 Elbows 124
9.11 Shoulders 127
9.12 Upper extremity amputations 133
9.13 Neurological impairments affecting the upper extremities 134
9.14 Upper extremity function 145
PART III—THE SPINE 148
Part III—Introduction 148
Part III—Definitions of clinical findings for diagnosis-related estimates in assessing spinal impairment 149
Part III—Multi-level fractures involving the spinal canal 151
9.15 Cervical spine—diagnosis-related estimates 152
9.16 Thoracic spine—diagnosis-related estimates 154
9.17 Lumbar spine—diagnosis-related estimates 156
9.18 Fractures of the pelvis 158
88
9.0 INTRODUCTION Figure 9-A: Activities of daily living
In conducting an assessment, the assessor must have regard Activity Examples

Self care, Bathing, grooming, dressing, eating,
personal hygiene eliminating.
Chapter 9 is divided into three parts: Hearing, speaking, reading, writing,
Communication
> Part I—The lower extremities using keyboard.
> Part II—Upper extremities Standing, sitting, reclining, walking,

stooping, squatting, kneeling, reaching,
> Part III—The spine. Physical activity bending, twisting, leaning, carrying,
lifting, pulling, pushing, climbing,
The range of motion to be measured is the range of active exercising.
motion. The medical assessor should be satisfied that the
claimant is making an appropriate effort to demonstrate the
maximal range and that the measurements are consistent Grasping, holding, pinching, percussive
Hand functions
(that is, several repetitions). The normal ranges of motion of movements, sensory discrimination.
individual joints in the musculoskeletal system are set out on the Travel Driving or travelling as a passenger.
next page.
Peripheral vascular disease affecting lower and upper extremities Sleep Having a restful sleep pattern.
is assessed under Table 1.4 and Table 1.5 (see Chapter 1—The
cardiovascular system).
For the purposes of Chapter 9, activities of daily living are those
in Figure 9-A.
89
Figure 9-B: Tables of normal ranges of motion of joints
Table Joint Plane ROM from ROM through ROM to

Hindfoot/Ankle
9.1 Frontal Eversion 20° 0° Inversion 30°
(subtalar)
9.2 Ankle (talocrural) Sagittal Extension 20° 0° Flexion 40°
9.3 Knee Sagittal Extension 0° Flexion 150°
9.4 Hip Rotation External Rotation 50° 0° Internal Rotation 40°
9.4 Hip Frontal Abduction 40° 0° Adduction 20°
9.4 Hip Sagittal Extension 30° 0° Flexion 100°
9.8.1.a Thumb—IP joint Extension 30° 0° Flexion 80°
9.8.1.a Thumb—MP joint Extension 40° 0° Flexion 60°
Thumb—radial 15° 50°

9.8.1.b
abduction/adduction (full radial adduction) (full radial abduction)
9.8.1.b Thumb adduction 0 cm 8 cm
9.8.1.b Thumb opposition 0 cm 8 cm
Index and middle
9.8.1.c Extension 30° 0° Flexion 70°
fingers—DIP joint
Index and middle
fingers—PIP joint
Index and middle
fingers—MP joint
Ring and little
9.8.1.d Extension 30° 0° Flexion 70°
fingers—DIP joint
Ring and little
fingers—PIP joint
Figure 9-B continued on following page.

90
Figure 9-B (continued)
Table Joint Plane ROM from ROM through ROM to

Ring and little
fingers—MP joint
9.9.1.a Wrist Sagittal Extension 60° 0° Flexion 60°
9.9.1.b Wrist Frontal Radial Deviation 20° 0° Ulnar deviation 30°
9.10.1.a Elbow Sagittal Extension 0° 0° Flexion 140°
9.10.1.b Elbow (forearm) Rotation Supination 80° 0° Pronation 80°
9.11.1.a Shoulder Sagittal Extension 40° 0° Flexion 180°
9.11.1.b Shoulder Rotation External rotation 90° 0° Internal Rotation 90°
9.11.1.c Shoulder Frontal Abduction 180° 0° Adduction 50°
91
PART I—THE LOWER EXTREMITIES—FEET AND TOES, ANKLES, KNEES
AND HIPS
PART I—INTRODUCTION If the medical assessor considers that the impairment is not
adequately assessed using one of Tables 9.1, 9.2, 9.3 and
The impairments assessed for each region in the lower extremity
9.4, and the condition does not cause a reduction in the range
are combined to obtain the overall impairment of the lower
of motion of a joint but there is significant interference with gait,
extremity for the individual extremity, subject to the notes
the medical assessor should consider the effect of the injury on
accompanying the applicable tables, or any indication that
gait and determine the WPI rating using Table 9.7. Table 9.7
combination is not permitted.
cannot be used if the condition causes a reduction in the range
Where an arthroplasty procedure has been undertaken, refer of motion of a joint and an assessment can be made under any
to the American Medical Association’s Guides to the Evaluation one or more of Table 9.1, 9.2, 9.3 or 9.4.
of Permanent Impairment 5th edition 2001. Combine the total
If permanent, conditions such as sesamoiditis, plantar fasciitis,
WPI rating for abnormal motion with the relevant WPI rating for
plantar tendonitis, and pes planus, should be assessed under
arthroplasty, obtained from the American Medical Association’s
Table 9.7.
Guide.
All ankylosis assessments from Tables 9.1, 9.2, 9.3 and 9.4
A WPI rating for one lower extremity may be combined with a
are alternative assessments to those for abnormal motion of the
WPI rating for the other lower extremity, except in the case of
individual joints.
WPI ratings under Table 9.7: Lower extremity function (see
page 108), where the notes accompanying Table 9.7 are The maximum WPI rating for a single lower extremity in Tables
followed. 9.1, 9.2, 9.3 and 9.4 is 40%, including combined WPI ratings.
WPI ratings from Table 9.1: Feet and Toes, Table 9.2: Ankles, Complex regional pain syndrome in the lower extremities should
Table 9.3: Knees or Table 9.4: Hips must not be combined with be assessed using the same methodology as for the upper
a WPI rating under Table 9.7 if they assess the same condition extremity substituting lower extremity table where appropriate.
in the same lower extremity. The diagnostic requirements of Figure 9-E apply.
Where a condition cannot be assessed under one of Tables

9.1, 9.2, 9.3 and 9.4, an assessment may be made under the
provisions of the American Medical Association’s Guides to the
Evaluation of Permanent Impairment 5th edition 2001.
92
Steps in calculating lower extremity impairment 9.1 FEET AND TOES
Add abnormal motion/ankylosis impairment values Table 9.1 assesses impairments to range of motion of the
Step 1 feet and toes, including ankylosis of one or more joints. The
within an individual joint.
maximum WPI rating under Table 9.1 is 2% for impairment of
Combine abnormal motion/ankylosis impairment
Step 2 two or more of the 2nd, 3rd, 4th and 5th toes of one foot.
values for different joints in the toes.
Add impairment values obtained for each individual In the case of toes, the ankylosis referred to in Table 9.1 is that
toe and combine this value with the impairment of the metatarso-phalangeal joint.
Step 3 values for other joints in the foot to obtain the
total abnormal motion/ankylosis impairment Ankylosis of the interphalangeal joints of the 2nd, 3rd, 4th or
assessment for a foot. 5th toe attracts a WPI rating of 0. The position of function is the
Combine with abnormal motion/ankylosis neutral position.
Step 4 impairment assessments for different regions in the
lower extremity (that is, knee and hip).
Combine with impairment values for peripheral
Step 5
nerve injuries.
Step 6 Combine with impairment values for amputation.
93
Table 9.1: Feet and toes
% WPI Criteria (one required—different conditions may be assessed separately)

0 Ankylosis of any one of the 2nd, 3rd, 4th or 5th toes in position of function.
Interphalangeal flexion of the 1st toe restricted to less than 20°.
Metatarso-phalangeal extension of the 1st toe restricted to a range of 15°-30°.
Metatarso-phalangeal extension of any one of the 2nd, 3rd, 4th and 5th toes restricted to less than 10°.
Subtalar inversion restricted to a range of 10°-20°.
1 Subtalar eversion restricted to less than 10°.
Ankylosis of:
> any one of the 2nd, 3rd, 4th or 5th toes in full extension or full flexion
> any two of the 2nd, 3rd, 4th or 5th toes in position of function
> the 2nd, 3rd and 4th toes in position of function.
Metatarso-phalangeal extension of the 1st toe restricted to less than 15°.
Metatarso-phalangeal extension of any two of the 2nd, 3rd, 4th or 5th toes restricted to less than 10°
Subtalar inversion restricted to less than 10°.
Ankylosis of:
> any two of the 2nd, 3rd or 4th toes, plus the 5th toe, in position of function
2
> any two of the 2nd, 3rd, 4th or 5th toes in full extension or full flexion
> all four of the 2nd, 3rd, 4th and 5th toes in position of function
> the 2nd toe with any two of the 3rd, 4th or 5th toes in full extension
> the 3rd, 4th and 5th toes in full extension or full flexion
> the 2nd and 3rd toes with either of the 4th or 5th toes in full flexion.
Ankylosis of:
3 > all four of the 2nd, 3rd, 4th and 5th toes in full flexion or full extension
> the 2nd toe with the 4th and 5th toes in full flexion.

94

Ankylosis of:
4 > the 1st toe in position of function or full extension
> the 1st toe with any one of the 2nd, 3rd, 4th or 5th toes in position of function.
Ankylosis of:
> the 1st toe in full flexion
5
> the 1st toe with any one of the 2nd, 3rd, 4th or 5th toes in full extension
> the 1st toe with any two or three of the 2nd, 3rd, 4th or 5th toes in position of function.
Ankylosis of:
> the 1st toe with any two or three of the 2nd, 3rd, 4th or 5th toes in full extension
6
> the 1st toe with all four of the 2nd, 3rd, 4th and 5th toes in position of function
> the 1st toe with any one of the 2nd, 3rd, 4th or 5th toes in full flexion.
Ankylosis of:
7 > the 1st toe with any two of the 2nd, 3rd, 4th or 5th toes in full flexion
> the 1st toe with all four of the 2nd, 3rd, 4th and 5th toes in full extension.
8 Ankylosis of the 1st toe with any three or all four of the 2nd, 3rd, 4th and 5th toes in full flexion.
10 Ankylosis of hindfoot with tibia-os calcis angle of 100° to 110°.
15 Ankylosis of hindfoot with tibia-os calcis angle of 90° to 95°.
20 Ankylosis of hindfoot with tibia-os calcis angle of less than 90°.
95
9.2 ANKLES
Table 9.2 assesses impairments to range of motion and deformity of the ankle, as well as ankylosis. Ankle deformity with movement
is assessed separately from ankylosis.
Ankylosis in the optimal position is equivalent to a WPI of 4%. The optimal position is the neutral position without flexion, extension,
varus or valgus. This is the base level of ankylosis impairment in the ankle.
When ankylosis is not in the optimal position, add the relevant WPI ratings from Table 9.2 for ankylosis in each direction. Then add
the base figure of 4% WPI for ankylosis in the optimal position.
The maximum WPI rating for multiple impairments of the ankle and hindfoot is 25% WPI. If the total WPI rating obtained by adding
different WPI ratings is higher than 25% WPI, then the final WPI rating for the ankle is 25%.
Table 9.2: Ankles
% WPI Criteria (one required—different conditions may be assessed separately—but see notes on ankylosis above)
Plantar flexion capability restricted to 15°-20°.
3
Dorsiflexion restricted to less than 10°.
4 Ankylosis in optimal position only (see notes).
Deformity with:
> varus angulation of 10°
> valgus angulation of 10°-20°.
5
Ankylosis not in optimal position:
> in less than 10° of internal malrotation
> in 15°of external malrotation.
Plantar flexion capability restricted to 10° or less.
6
Plantar flexion contracture of 10°-15°.
7
> in 10° to 15° of dorsiflexion or plantar flexion.

96
% WPI Criteria (one required—different conditions may be assessed separately—but see notes on ankylosis above)
Deformity with varus angulation of 15°-20°.
> in varus angulation of 5°
10
> in valgus angulation of 10° to 15°
> in 10° to 15° of internal malrotation
> in 20° to 25° of external malrotation
12 Plantar flexion contracture of at least 20°.
> in 20° to 25° of plantar flexion
> in at least 20° of dorsiflexion
15 > in varus angulation of 10° to 15°
> in valgus angulation of 20° to 25°
> in 30° to 35° of external malrotation.
17
> in varus angulation of 20° to 25°.
20 Deformity with varus angulation of 25° or greater.
> in varus angulation of at least 30°
> in at least 30° of plantar flexion
21
> in valgus angulation of at least 30°
> in at least 30° of internal malrotation
> in at least 40° of external malrotation.
97
9.3 KNEES
Table 9.3 assesses impairments to range of motion and deformity of the knee, as well as ankylosis. Knee deformity with movement is
assessed separately from ankylosis. ‘Deformity’ is measured by the femoral-tibial angle: 3°-10° valgus is considered normal.
Ankylosis in the optimal position is equivalent to 27% WPI. The optimal position is 10°-15° of flexion with good alignment. This is
the base level of ankylosis impairment in the knee. When ankylosis is not in the optimal position, add the relevant WPI ratings from
Table 9.3 for ankylosis in each direction. Then add the base figure of 27% WPI for ankylosis in the optimal position.
The maximum WPI rating for multiple impairments of the knee is 40% WPI. If the total WPI rating obtained by adding different WPI
ratings is over 40%, then the final WPI rating for the knee is 40%.
Table 9.3: Knees

Flexion of 80°-105°.
Flexion contracture of 5°.
Deformity with:
> varus angulation of 2° valgus-0° (neutral)
5 Ankylosis not in optimal position:
> in less than 10° of varus
> in 10° to 15° of valgus
> in 20° to 25° of flexion.

98

Flexion contracture of 10°-15°.
Deformity with:
> varus angulation of 1°-7°
10 Ankylosis not in optimal position:
> in 10° to 15° of varus
> in 20° to 25° of valgus
> in 30° to 35° of flexion.
> in at least 30° of internal malrotation
> in at least 30° of external malrotation
13
> in at least 20° of varus
> in at least 30° of valgus
> in at least 40° of flexion.
Flexion contracture of 20° or greater.
14 Deformity with:
> varus angulation of more than 12°
> valgus angulation of more than 20°.
Flexion of less than 30°.
Deformity with:
20
> varus angulation of more than 12°
> valgus angulation of more than 20°.
27 Ankylosis in optimal position only (see notes above).
99
9.4 HIPS
Table 9.4 assesses impairments of range of motion and deformity of the hip, as well as ankylosis. Hip deformity with movement is
assessed separately from ankylosis.
Ankylosis in the optimal position is 20% WPI. The optimal position is 25°-40° of flexion with neutral rotation, abduction and
adduction. This is the base level of ankylosis impairment in the hip. When ankylosis is not in the optimal position, add the relevant
WPI ratings from Table 9.4 for ankylosis in each direction. Then add the base figure of 20% WPI for ankylosis in the optimal position.
The maximum WPI rating for multiple impairments of the hip is 40%. If the total WPI rating obtained by adding different WPI ratings
is over 40%, then the final WPI rating for the hip is 40%.
Table 9.4: Hips

Flexion restricted to 80°-100°.
Internal rotation restricted to 10°-15°.
2 External rotation restricted to 20°-30°.
Abduction restricted to 15°-25°.
Adduction restricted to 15° or less.
Abduction contracture of 5° or less.
Flexion restricted to 50°-70°.
Internal rotation restricted to less than 10°.
External rotation restricted to less than 20°.
Abduction restricted to 5°-10°.
5
Abduction contracture of 6°-10°.
> in 20° to 40° of flexion
> in at least 5° of internal rotation
> in 10°-15° of external rotation.

100

Flexion restricted to less than 50°.
Flexion contracture of 30° or more.
Abduction restricted to less than 5°.
Abduction contracture of 11°-20°.
10
> in at least 10° of internal rotation
> in at least 20° of external rotation
> in 5°-10° of abduction
> in at least 5° of adduction.
Abduction contracture of more than 20°.
15 > in at least 20° of internal rotation
> in 15°-20° of abduction
Ankylosis in optimal position (see notes above).
> in at least 70° of flexion
20 > in at least 30° of internal rotation
> in at least 25° of abduction
101
9.5 LOWER EXTREMITY AMPUTATIONS
Table 9.5 is the only table used to assess impairment arising from amputations in the lower extremity.
Table 9.7: Lower extremity function must not be used in cases involving amputations.
A WPI rating from Table 9.5 may be combined with other WPI ratings for lower extremity conditions above the amputation site.
Table 9.5: Lower extremity amputations

Amputation through:
> interphalangeal joint (distal or proximal) of any one of 2nd, 3rd, 4th or 5th toes
0
> any phalanx of any one of the 2nd, 3rd, 4th or 5th toes.
Amputation of any portion of soft tissue of any toe.
1 Amputation of any one of the 2nd, 3rd, 4th or 5th toes at the metatarso-phalangeal joint.
Amputation of:
> the first toe at the interphalangeal joint
2
> any toe except the first toe through the metatarsal
> any two of the 2nd, 3rd, 4th or 5th toes at the metatarso-phalangeal joint.
3 Amputation of any three of the 2nd, 3rd, 4th and 5th toes at the metatarso-phalangeal joint.
4 Amputation of all four of the 2nd, 3rd, 4th and 5th toes at the metatarso-phalangeal joint.
5 Amputation of the first toe at the metatarso-phalangeal joint.
8 Amputation of the first metatarsal (first toe).
10 Amputation of all toes of one foot at the metatarso-phalangeal joints.
16 Transmetatarsal amputation.
18 Midfoot amputation.
25 Syme amputation of hindfoot.

102

28 Amputation of lower leg more than 7.5cm below knee.
Amputation of lower leg 7.5cm or less below knee.
32 Knee disarticulation.
Amputation above knee distal to midthigh.
36 Amputation above knee through midthigh.
Amputation above knee proximal to midthigh.
40
Hip disarticulation.
50 Hemipelvectomy.
103
9.6 SPINAL NERVE ROOT IMPAIRMENTS AND PERIPHERAL NERVE INJURIES AFFECTING THE LOWER EXTREMITIES
Figure 9-C: Grading system
Sensory deficits or pain Motor function

Grading
Criteria Criteria
No sensation
0 or No contraction.
Severe pain that prevents all activity.
No protective sensibility with abnormal sensations
1 or A flicker.
Severe pain that prevents most activity.
Decreased protective sensibility with abnormal sensations
2 or Active movement with gravity eliminated.
Severe pain that prevents some activity.
Diminished light touch and two-point discrimination with some abnormal
sensations
3 Active movement against gravity.
or
Slight pain that interferes with some activity.
Diminished light touch with or without minimal abnormal sensations
Active movement against gravity and
4 or
resistance.
Pain that is forgotten during activity.
Normal sensation
5 or Normal power.
No pain.
104
9.6.1 Spinal nerve root impairment affecting the lower extremity
Table 9.6.1 is to be used where there is involvement of a single spinal nerve. Where there are multiple nerves involved, the respective
WPI ratings for each involved nerve should be combined.
Values obtained for pain, discomfort and/or sensory loss should be combined with values obtained for loss of strength, using the
combined values chart (see Appendix 1).
Where the same nerve root is assessed, Table 9.6.1 must not be used in conjunction with Table 9.17: Lumbar spine.
Table 9.6.1: Spinal nerve root impairment affecting the lower extremity
Impairment causing pain, Impairment causing loss of

discomfort and/or sensory loss strength
Grading Grading
5 4 3 2 1 0 5 4 3 2 1 0
Nerve root % WPI % WPI Nerve root
L3 0 1 1 2 3 3 0 2 3 5 7 8 L3
L4 0 1 1 2 3 3 0 3 6 8 12 14 L4
L5 0 1 1 2 3 3 0 3 6 9 13 15 L5
S1 0 1 1 2 3 3 0 2 3 5 7 8 S1
105
9.6.2 Peripheral nerve injuries affecting the lower extremities
WPI ratings obtained for sensory impairment should be combined with WPI ratings for dysaesthesia, and the total combined with WPI
ratings for motor impairment, using the combined values chart (see Appendix 1).
Where the same nerve is assessed, Table 9.6.2a and Table 9.6.2b must not be used in conjunction with Table 9.17: Lumbar spine.
Use the grading system shown in Figure 9-C: Grading system.
Table 9.6.2a: Sensory impairment due to peripheral nerve injuries affecting the lower extremities
Sensory Dysaesthesia
grading grading
5 4 3 2 1 0 5 4 3 2 1 0
Femoral 0 0 0 1 1 1 0 1 1 2 3 3 Femoral
Lateral femoral cutaneous 0 0 0 1 1 1 0 1 1 2 3 3 Lateral femoral cutaneous
Sciatic 0 1 3 5 6 7 0 1 2 4 5 5 Sciatic
Common peroneal 0 0 1 1 2 2 0 0 1 1 2 2 Common peroneal
Tibial 0 1 2 4 4 5 0 1 1 3 3 3 Tibial
Superficial peroneal 0 0 1 1 2 2 0 0 1 1 2 2 Superficial peroneal
Sural 0 0 0 1 1 1 0 0 1 1 2 2 Sural
Medial plantar 0 0 1 1 2 2 0 0 1 1 2 2 Medial plantar
Lateral plantar 0 0 1 1 2 2 0 0 1 1 2 2 Lateral plantar
106
Table 9.6.2b: Motor impairment due to peripheral nerve 9.7 LOWER EXTREMITY FUNCTION
injuries affecting the lower extremities
Table 9.7 (see page 108) should only be used to assess
Motor impairment from objectively identified orthopaedic or
grading neurological conditions arising in and affecting the lower
extremities. It may not be used to assess impairment from
5 4 3 2 1 0 conditions manifesting principally as pain with no clinically
Nerve % WPI demonstrable lower extremity pathology.
Femoral 0 3 6 9 13 15 A secondary dysfunction consequent to disuse is only

Obturator 0 1 1 2 3 3 assessable under Table 9.7 if this dysfunction is permanent
(that is, not likely to improve as a result of surgery, medication
Superior gluteal 0 5 10 15 21 25 or other rehabilitative treatment) and there are objective clinical
Inferior gluteal 0 3 6 9 13 15 findings that can be validly assessed using other tables in
Chapter 9, Part 1—The lower extremities.
Sciatic 0 6 12 18 26 30
Common peroneal 0 3 6 9 13 15 If permanent, conditions such as sesamoiditis, plantar fasciitis,
plantar tendonitis, and pes planus, should be assessed under
Tibial 0 3 6 9 13 15
Table 9.7.
Medial plantar 0 0 1 1 2 2
Table 9.7 must not be used in cases involving amputations.
Lateral plantar 0 0 1 1 2 2
A single assessment only may be made under Table 9.7,
regardless of whether one or two extremities are affected by
the injury. The impairment assessed under Table 9.7 is of
overall lower extremity function, rather than that of individual
extremities.
107
Before using Table 9.7 the medical assessor should check Table 9.7 may be used to assess lower extremity impairment
the instructions (see Part I—Introduction, page 91) preceding arising as a result of spinal cord damage. Observe the special
the specific joint impairment tables (Tables 9.1–9.4) and use procedure set out in the introduction to Part III of this Chapter.
Table 9.7 strictly in accordance with those instructions. In However, Table 9.7 is not to be used to assess lower extremity
particular, Table 9.7 cannot be used where the condition causes impairment arising as a result of nerve root compression, or
a reduction in the range of motion of a joint and an assessment other neurological sequelae of other spinal conditions. These
can be made under any one or more of Table 9.1, 9.2, 9.3 or should be assessed under:
9.4.
> Table 9.6.1, Table 9.6.2a or Table 9.6.2b (tables dealing
Where only one limb is affected, regardless of the number of with spinal nerve root impairments and peripheral nerve
impairments found in that limb, the limb should be assessed injuries affecting the lower extremities, see pages 104-106)
using the relevant tables other than Table 9.7 and all > Table 9.15: Cervical spine
impairments combined using the combined values table (see
> Table 9.16: Thoracic spine
Appendix 1). The combined impairment rating should then
be compared with the rating taken from the relevant row in > Table 9.17: Lumbar spine.
Table 9.7 and the higher rating obtained from the two methods
To fulfil the requirements of a WPI rating in Table 9.7, there must
chosen.
be one major criterion and at least two minor criteria present
Where both limbs are affected, each limb should be assessed (where minor criteria are listed).
using the relevant tables other than Table 9.7 and all
‘Manifest difficulty’ is difficulty (such as stumbling, or an altered
impairments in both limbs combined using the combined values
gait) evident to the medical assessor. The difficulty must be
table (see Appendix 1). The combined impairment rating should
tested clinically: history alone cannot be relied upon in the
then be compared with the rating taken from the relevant row in
assessment.
Table 9.7 and the higher rating obtained from the two methods
chosen.
108
Table 9.7: Lower extremity function
Major criteria Minor criteria

% WPI
(at least one required) (at least two required where listed)
Walks at a normal pace in comparison with peers on
level ground or uneven ground and can avoid obstacles
or
0
Distance walked is not restricted by the condition being
assessed (although other factors such as the level of
fitness may cause restriction).
level ground but has manifest difficulty negotiating
uneven ground and avoiding obstacles Legs give way or lock occasionally without causing falls.
5 Can negotiate three or more stairs or a ramp (up and
or
down) without the use of a walking aid or hand rails.
Walking is restricted to 1000m or less (may be able to
walk further after resting).
Legs give way or lock occasionally without causing falls.
level ground but is unable to negotiate uneven ground
without use of a walking aid or personal assistant Is unable to negotiate three or more stairs or a ramp (up
10 and down) without the use of a walking aid or hand
or
rails.
walk further after resting).
Walks at a moderately reduced pace in comparison with Legs give way occasionally causing falls.
peers on level ground Is unable to negotiate three or more stairs or a ramp (up
20 or and down) without use of a walking aid or band rails.
Walking is restricted to 250m or less (may be able to Is unable to rise from sitting to standing position without
walk further after resting). use of one hand but can stand without support.

109

% WPI
(at least one required) (at least two required where listed)
Legs give way frequently causing falls.
Walks at a significantly reduced pace in comparison Demonstrated medical need for a brace or walking aid
with peers on level ground (walking stick or crutches) on level ground.
30 or Is unable to negotiate three or more stairs or a ramp (up
Walking is restricted to 100m or less (may be able to and down) without assistance from another person.
walk further after resting). Is unable to rise from sitting to standing position without
use of both hands but can stand without support.
Is restricted to walking around house and yard.
Walks at a greatly reduced pace in comparison with Demonstrated medical need for a walking aid (walking
peers on level ground stick or crutches) when walking on level ground.
40 or Is unable to negotiate three or more stairs or a ramp (up
and down) under any circumstances.
walk further after resting). Is unable to rise from sitting to standing position without
personal assistance and is unable to stand without
support.
Is restricted to walking around house.
Walks at a very slow pace in comparison with peers on Demonstrated medical need for a quad stick or walking
level ground frame as support when standing and walking.
50 or Is unable to negotiate any steps or ramps.
Walking is restricted to 25m or less (may be able to Is unable to rise from sitting to standing position without
walk further after resting). personal assistance and is unable to stand without
support.
Can stand with support of personal assistant but is
60
unable to walk.
64 Unable to stand or walk.
110
PART II—THE UPPER EXTREMITIES: HANDS AND FINGERS, WRISTS,
ELBOWS AND SHOULDERS
PART II—INTRODUCTION Where a condition cannot be assessed under a specific table in

the upper extremities group, an assessment may be made under
The impairments assessed for each region in each upper
the provisions of the American Medical Association’s Guides to
extremity are combined (that is, hand, wrist, elbow, shoulder).
the Evaluation of Permanent Impairment 5th edition 2001.
The WPI rating for one upper extremity may be combined with
All ankylosis assessments from tables in the upper extremities
a WPI rating for the other upper extremity, except in the case of
group are alternative assessments to those for abnormal motion
assessments under Table 9.14, where the notes appearing prior
of the individual joints.
to Table 9.14 are to be followed.
The maximum WPI rating for a single upper extremity is 60%,
WPI ratings from the following tables must not be combined with
including combined WPI ratings.
a WPI rating under Table 9.14 if they assess the same condition
in the same upper extremity:
Steps in calculating upper extremity impairment
> Tables 9.8.1a, 9.8.1b, 9.8.1c, 9.8.1d (tables dealing with
Note that sensory loss in the digit is assessed either as a digit
abnormal motion of digits)
impairment or as a peripheral nerve impairment as appropriate,
> Tables 9.8.2a, 9.8.2b, 9.8.2c, 9.8.2d (tables dealing with but not both.
sensory losses in thumb and fingers)
> Tables 9.9.1a, 9.9.1b (tables dealing with wrists) Add abnormal motion/ankylosis impairment values
Step 1
within an individual joint.
> Tables 9.10.1a, 9.10.1b (tables dealing with elbows)
Add abnormal motion/ankylosis impairment values
Step 2
> Tables 9.11.1a, 9.11.1b, 9.11.1c (tables dealing with for different joints in the thumb.
shoulders). Combine impairment values for different joints in
Step 3
the other four digits.
If the medical assessor considers that the impairment is not
adequately assessed using one of Tables 9.9, 9.10, and 9.11, Combine impairment values for each digit for
and the condition involves radiographically demonstrated joint Step 4 sensory loss due to digital nerve injury and/or
amputation.
instability, radiographically demonstrated arthritis or where the
employee has had an arthroplasty, the medical assessor may Add impairment values for each digit to obtain the
Step 5
consider the effect of the injury on upper extremity function total hand assessment.
instead and determine the WPI rating using Table 9.14. Combine with impairment values for different
Table 9.14 cannot be used unless the condition involves Step 6
regions in the upper extremity.
radiographically demonstrated joint instability or arthritis or the
employee has had an arthroplasty.
111
9.8 HANDS AND FINGERS
Add the WPI ratings for each individual digit to obtain the total
WPI rating for the hand.
WPI ratings for abnormal motion or ankylosis of digits are

combined with those for sensory losses in the same digits.
9.8.1 Abnormal motion of digits
Table 9.8.1a, Table 9.8.1b, Table 9.8.1c and Table 9.8.1d

assess impairments to range of motion of the digits of the hand,
including ankylosis of one or more joints.
Impairment values for flexion and extension losses in each

individual joint are added to obtain the total WPI rating for loss
of range of motion of that joint.
Where there is abnormal motion or ankylosis of more than one

joint of the same finger, the WPI ratings for abnormal motion or
ankylosis are combined to obtain the WPI rating for that finger.
Where there is abnormal motion or ankylosis of more than

one joint of the thumb, the WPI ratings for abnormal motion or
ankylosis are added to obtain the WPI rating for the thumb.
112
Table 9.8.1a: Abnormal motion/ankylosis of the thumb—IP and MP joints
See notes to Table 9.8.1a on page 117.
Direction IP joint MP joint Direction

Loss of Loss of Loss of Loss of
Extension/ Ankylosis Ankylosis Extension/
extension flexion extension flexion
hyperextension hyperextension
%WPI %WPI %WPI %WPI %WPI %WPI
2 0 2 40°
30° 3 0 3 2 0 2 30°
20° 3 0 3 2 0 2 20°
10° 2 0 2 2 0 2 10°
0° 2 0 2 1 0 1 0°
10° 2 1 1 1 0 1 10°
20° 2 1 1 1 0 1 20°
30° 2 1 1 1 1 1 30°
40° 2 2 1 2 1 1 40°
50° 2 2 1 2 2 0 50°
60° 3 2 0 2 2 0 60°
70° 3 3 0
80° 3 3 0
Flexion Flexion
113
Table 9.8.1b: Radial abduction/adduction/opposition of the thumb—abnormal motion/ankylosis
See notes to Table 9.8.1b on page 117.

Loss of less than 10° of radial adduction.
Loss of less than 35° of radial abduction.
0
Lack of less than 3cm adduction.
Thumb opposition of more than 6 cm.
Loss of 10°-20° of radial adduction.
Loss of 35°-40° of radial abduction.
1 Lack of 3-5 cm adduction.
Thumb opposition of 5 to 6 cm.
Ankylosis in 30° to 35° of radial abduction.
Loss of 25° or more of radial adduction.
Loss of 45° or more of radial abduction.
Lack of 6cm adduction.
2
Ankylosis in 15°-25°, or 40°-50° of radial abduction.
Ankylosis in 4cm of adduction.
Thumb opposition of 4cm.
3 Thumb opposition of 3cm.
Ankylosis in 3cm or 5cm of adduction.
4
Ankylosis in 0-2cm or 6-8cm of adduction.
5
Ankylosis in thumb opposition of 5-6cm.
6 Ankylosis in thumb opposition of 4cm or 7cm.
Table 9.8.1b continued on following page.

114
Table 9.8.1b (continued)

7
Ankylosis in thumb opposition of 3cm or 8cm.
8 Ankylosis in thumb opposition of 1 or 2cm.
10
Ankylosis in thumb opposition of 0cm.
115
Table 9.8.1c: Abnormal motion/ankylosis of the fingers—index and middle fingers
See notes to Table 9.8.1c on page 117.
Direction Index and middle fingers Direction

DIP joint PIP joint MP joint
Extension/ Loss of Loss of Loss of Loss of Loss of Loss of Extension/
Ankylosis Ankylosis Ankylosis
hyperextension extension flexion extension flexion extension flexion hyperextension
%WPI %WPI %WPI %WPI %WPI %WPI %WPI %WPI %WPI
30° 5 0 5 8 0 8 30°
20° 4 0 4 8 0 8 7 0 7 20°
10° 4 0 4 7 0 7 6 1 6 10°
0° 4 0 4 7 0 7 6 1 5 0°
10° 4 0 3 6 1 6 5 1 5 10°
20° 3 1 3 6 1 5 5 1 4 20°
30° 4 1 2 6 1 4 5 1 4 30°
40° 4 2 2 5 2 4 6 3 3 40°
50° 4 3 1 6 3 3 7 4 2 50°
60° 4 4 1 7 4 3 8 6 2 60°
70° 5 5 0 7 5 2 8 8 1 70°
80° 8 7 1 10 9 1 80°
90° 8 8 1 11 11 0 90°
100° 8 8 0 100°
Flexion Flexion
116
Table 9.8.1d: Abnormal motion/ankylosis of the fingers—ring and little fingers
See notes to Table 9.8.1d on page 117.
Direction Ring and little fingers Direction

DIP joint PIP joint MP joint
Extension/ Loss of Loss of Loss of Loss of Loss of Loss of Extension/
Ankylosis Ankylosis Ankylosis
hyperextension extension flexion extension flexion extension flexion hyperextension
%WPI %WPI %WPI %WPI %WPI %WPI %WPI %WPI %WPI
30° 3 0 3 4 0 4 30°
20° 2 0 2 4 0 4 3 0 3 20°
10° 2 0 2 4 0 4 3 0 3 10°
0° 2 0 2 3 0 3 3 1 3 0°
10° 2 0 2 3 0 3 3 1 2 10°
20° 2 0 2 3 1 3 3 1 2 20°
30° 2 1 1 3 1 2 3 1 2 30°
40° 2 1 1 3 1 2 3 2 2 40°
50° 2 2 1 3 2 2 3 2 1 50°
60° 2 2 1 3 2 1 4 3 1 60°
70° 3 3 0 4 3 1 4 4 1 70°
80° 4 3 1 5 5 1 80°
90° 4 4 1 5 5 0 90°
100° 4 4 0 100°
Flexion Flexion
117
Notes to Tables 9.8.1a, 9.8.1b, 9.8.1c and 9.8.1d
1. Abbreviations:
IP = interphalangeal.
MP = metacarpo-phalangeal.
CMC = carpometacarpal.
PIP = Proximal interphalangeal.
DIP = Distal interphalangeal.
2. Thumb adduction is the smallest possible distance from the flexor crease of the IP joint of the thumb to the distal palmar crease
over the level of the MP joint of the little finger. The normal range of adduction of the thumb is from 8 cm to 0cm.
3. Thumb radial abduction is the largest angle of separation actively formed between the first and second metacarpals in the
coronal plane. The normal angle of radial abduction is 50°. The smallest angle of thumb radial adduction is 15°.
4. Opposition of the thumb is measured as the largest achievable distance between the flexor crease of the IP joint of the thumb to
the distal palmar crease directly over the third MP joint. The normal range of opposition of the thumb is from 0 cm to 8 cm. In
the case of employees with small hands, compare the loss of opposition with the normal range of opposition in the unaffected
hand.
5. Optimal positions of thumb and fingers:
Joint Optimal position Joint Optimal position

Thumb IP 20° of flexion Finger DIP 20° of flexion
Thumb MP 20° of flexion Finger PIP 40° of flexion
Thumb CMC 30°-35° of radial abduction Finger MP 30° of flexion
118
9.8.2 Sensory losses in the thumb and fingers WPI ratings for transverse sensory loss must not be combined
with WPI ratings for longitudinal sensory loss in the same digit.
Table 9.8.2a, Table 9.8.2b, Table 9.8.2c, and Table 9.8.2d
The conditions of transverse sensory loss and longitudinal
(see pages 119-120) assess sensory losses in the thumb and
sensory loss in an individual digit are mutually exclusive.
fingers due to digital nerve lesions only.
WPI ratings for sensory losses in digits are combined with those
Sensory losses due to peripheral nerve lesions are assessed
for abnormal motion or ankylosis in the same digits.
under Tables 9.13.1, 9.13.2a and 9.13.2b (tables dealing with
neurological impairments affecting the upper extremities. For the thumb and little finger, losses involving the ulnar digital
nerve are rated higher than those of the radial digital nerve. For
The two-point discrimination test is used to determine sensory
the other fingers, losses involving the radial digital nerve are
loss:
rated higher than those of the ulnar digital nerve.
> Total sensory loss = two-point discrimination of greater
If the little finger has been amputated, the ring finger is assessed
than 15mm
as if it were the little finger.
> Partial sensory loss = two-point discrimination of
7 to 15mm.
Two-point discrimination of less than 7 mm is not treated as an

impairment.
Transverse sensory loss involves both digital nerves (ulnar and

radial). Longitudinal sensory loss involves a single digital nerve
(ulnar or radial).
Determine the percentage of digit length involved using the

method in the American Medical Association’s Guides to the
Evaluation of Permanent Impairment 5th edition 2001 and
consult Table 9.8.2a, Table 9.8.2b, Table 9.8.2c, and Table
9.8.2d, using the corresponding WPI rating for the nerve or
nerves involved.
119
Table 9.8.2a: Sensory losses in the thumb Table 9.8.2b: Sensory losses in the index and middle fingers
% WPI (thumb) % WPI (index and middle fingers)

Transverse Transverse
Longitudinal loss Longitudinal loss
Percentage of loss Percentage of loss
digit length Both digital Ulnar digital Radial digit length Both digital Ulnar digital Radial
nerves nerve digital nerve nerves nerve digital nerve
Total Partial Total Partial Total Partial Total Partial Total Partial Total Partial
10 1 1 1 1 1 0 10 1 1 0 0 1 0
20 2 1 1 1 1 1 20 1 1 1 0 1 1
30 3 2 2 1 1 1 30 2 1 1 1 1 1
40 4 2 3 1 2 1 40 2 1 1 1 1 1
50 5 3 3 2 2 1 50 3 2 1 1 2 1
60 7 3 4 2 3 1 60 3 2 1 1 2 1
70 8 4 4 2 3 2 70 4 2 2 1 2 1
80 8 4 5 3 3 2 80 4 2 2 1 3 1
90 10 5 6 3 4 2 90 5 3 2 1 3 2
100 11 5 7 3 4 2 100 5 3 2 1 3 2
120
Table 9.8.2c: Sensory losses in the little finger Table 9.8.2d: Sensory losses in the ring finger
% WPI (little finger) % WPI (ring finger)

Transverse Transverse
Longitudinal loss Longitudinal loss
Percentage of loss Percentage of loss
digit length Both digital Ulnar digital Radial digit length Both digital Ulnar digital Radial
nerves nerve digital nerve nerves nerve digital nerve
Total Partial Total Partial Total Partial Total Partial Total Partial Total Partial
10 1 0 0 0 0 0 10 1 0 0 0 0 0
20 1 1 1 0 0 0 20 1 1 0 0 1 0
30 1 1 1 1 1 0 30 1 1 1 0 1 1
40 1 1 1 1 1 0 40 1 1 1 0 1 1
50 2 1 1 1 1 1 50 2 1 1 1 1 1
60 2 1 1 1 1 1 60 2 1 1 1 1 1
70 2 1 1 1 1 1 70 2 1 1 1 1 1
80 2 1 1 1 1 1 80 2 1 1 1 1 1
90 3 1 2 1 1 1 90 3 1 1 1 2 1
100 3 2 2 1 1 1 100 3 2 1 1 2 1
121
9.9 WRISTS For ankylosis, the optimal position for arthrodesis of the wrist
is approximately 15°-20° of dorsiflexion with slight ulnar
Table 9.9.1a and Table 9.9.1b (see pages 122-123) assess
deviation.
impairments to range of motion of the wrists, including
ankylosis. The maximum possible wrist impairment is 35% WPI.
Loss of range of motion in each functional plane is measured For the same condition, a WPI rating from Table 9.9.1a or Table
from the neutral position. The range of motion is expressed 9.9.1b may not be combined with a WPI rating from Table
as the two achievable limits of active motion in each direction 9.14: Upper extremity function.
through the normal range of motion. It is possible that the only
motion that can be achieved is between two points on one side
of the neutral position.
The WPI rating for restriction of motion in one direction is

determined according to the active motion than can be achieved
in that direction. It is then added to the WPI rating for the active
motion in the reverse direction.
Add the abnormal motion WPI ratings for each direction

of motion for both wrist flexion/extension and radial/ulnar
deviation. Where there is ankylosis, including after an
arthrodesis procedure, the assessment should be made only
under the ankylosis scale.
Where an arthroplasty procedure has been undertaken, refer

to the American Medical Association’s Guides to the Evaluation
Guides.
122
Table 9.9.1a: Wrist flexion/extension
Direction Ankylosis Loss of extension Loss of flexion Direction

Extension %WPI %WPI %WPI Extension
60° 25 0 25 60°
50° 22 1 22 50°
40° 17 2 15 40°
30° 16 3 13 30°
20° 14 4 10 20°
10° 13 5 8 10°
0° 13 7 6 0°
10° 13 8 5 10°
20° 15 11 4 20°
30° 17 14 3 30°
40° 20 18 2 40°
50° 23 22 1 50°
60° 25 25 0 60°
Flexion Flexion
123
Table 9.9.1b: Radial and ulnar deviation of wrist joint
Direction Ankylosis Loss of radial deviation Loss of ulnar deviation Direction

Radial deviation %WPI %WPI %WPI Radial deviation
20° 11 0 11 20°
15° 10 1 9 15°
10° 8 1 7 10°
5° 7 2 5 5°
0° 5 2 3 0°
5° 5 3 2 5°
10° 5 3 2 10°
15° 7 5 2 15°
20° 8 7 1 20°
25° 10 9 1 25°
30° 11 11 0 30°
Ulnar deviation Ulnar deviation
124
9.10 ELBOWS For ankylosis, the optimal or functional position is 80° of flexion
and 20° of pronation.
Table 9.10.1 and Table 9.10.1b (see pages 125-126) assess
impairments to range of motion of the elbows, including The maximum possible elbow impairment is 40% WPI.
ankylosis.
For the same condition, a WPI rating from Table 9.10.1a or
Loss of range of motion in each functional plane is measured Table 9.10.1b may not be combined with a WPI rating from
from the neutral position. The range of motion is expressed Table 9.14: Upper extremity function.
as the two achievable limits of active motion in each direction

Add the abnormal motion WPI rating for each direction of motion
for both elbow flexion/extension and pronation/supination.
Where there is ankylosis, including after an arthrodesis
procedure, the assessment should be made only under the
ankylosis scale.
Where an arthroplasty procedure has been undertaken, refer

to the American Medical Association’s Guides to the Evaluation
Guides.
125
Table 9.10.1a: Elbow flexion/extension

Flexion %WPI %WPI %WPI Flexion
140° 25 25 0 140°
130° 23 22 1 130°
120° 20 19 1 120°
110° 19 16 2 110°
100° 16 13 4 100°
90° 15 10 5 90°
80° 13 7 6 80°
70° 14 5 9 70°
60° 15 4 11 60°
50° 17 3 14 50°
40° 19 2 16 40°
30° 20 2 19 30°
20° 22 1 20 20°
10° 23 1 22 10°
0° 25 0 25 0°
Extension Extension
126
Table 9.10.1b: Pronation and supination of forearm
Direction Ankylosis Loss of pronation Loss of supination Direction

Supination %WPI %WPI %WPI Supination
80° 17 17 0 80°
70° 16 16 0 70°
60° 16 15 1 60°
50° 15 14 1 50°
40° 14 13 1 40°
30° 14 13 1 30°
20° 13 11 2 20°
10° 11 9 2 10°
0° 9 7 2 0°
10° 7 5 2 10°
20° 5 2 2 20°
30° 5 2 4 30°
40° 7 2 5 40°
50° 9 1 8 50°
60° 11 1 11 60°
70° 14 1 13 70°
80° 17 0 17 80°
Pronation Pronation
127
9.11 SHOULDERS The maximum possible shoulder impairment is 35% WPI.
Table 9.11.1a, Table 9.11.1b and Table 9.11.1c assess For the same condition, a WPI rating from Table 9.11.1a,
impairments to range of motion of the shoulders, including Table 9.11.1b or Table 9.11.1c may not be combined with a
ankylosis. WPI rating from Table 9.14: Upper extremity function.
Loss of range of motion in each functional plane is measured

from the neutral position. The range of motion is expressed
as the two achievable limits of active motion in each direction

Add the abnormal motion WPI ratings for each direction of

motion for shoulder flexion/extension, abduction/adduction and
internal/external rotation. Where there is ankylosis, including
after an arthrodesis procedure, the assessment should only be
made under the ankylosis scale.
Where an arthroplasty procedure has been undertaken, refer to

the American Medical Association’s Guides to the Evaluation of
Permanent 5th edition 2001. Combine the total WPI rating for
abnormal motion with the relevant WPI rating for arthroplasty,
obtained from the American Medical Association’s Guides.
For ankylosis, the optimal or functional position is 20°-40° of

flexion, 20°-50° of abduction and 30°-50° of internal rotation.
Unless the shoulder has been arthrodesed, an assessment for
ankylosis under this table would be rare.
128
Table 9.11.1a: Shoulder flexion/extension

180° 18 18 0 180°
170° 18 17 1 170°
160° 17 17 1 160°
150° 17 16 1 150°
140° 17 16 2 140°
130° 17 15 2 130°
120° 17 14 2 120°
110° 17 14 3 110°
100° 16 13 3 100°
90° 16 13 4 90°
80° 15 11 4 80°
70° 13 9 4 70°
60° 12 7 5 60°
50° 10 5 5 50°
40° 9 3 6 40°
30° 9 3 6 30°
20° 9 2 7 20°
10° 11 2 10 10°
Table 9.11.1a continued on following page.

129
Table 9.11.1a (continued)

0° 14 2 13 0°
10° 15 1 14 10°
20° 16 1 14 20°
30° 16 1 16 30°
40° 17 1 17 40°
50° 18 0 18 50°
Extension Extension
130
Table 9.11.1b: Shoulder—internal/external rotation
Direction Ankylosis Loss of external rotation Loss of internal rotation Direction

External rotation %WPI %WPI %WPI External rotation
90° 7 0 7 90°
80° 7 0 7 80°
70° 7 0 7 70°
60° 6 0 6 60°
50° 6 1 5 50°
40° 5 1 5 40°
30° 5 1 5 30°
20° 5 1 4 20°
10° 5 1 4 10°
0° 4 1 3 0°
10° 4 1 3 10°
20° 4 1 2 20°
30° 4 1 2 30°
40° 4 2 2 40°
50° 4 2 1 50°
60° 4 3 1 60°
70° 5 5 1 70°
80° 6 6 0 80°
90° 7 7 0 90°
Internal rotation Internal rotation
131
Table 9.11.1c: Abduction/adduction of shoulder
Direction Ankylosis Loss of adduction Loss of abduction Direction

Abduction %WPI %WPI %WPI Abduction
180° 11 11 0 180°
170° 11 11 0 170°
160° 10 10 1 160°
150° 10 10 1 150°
140° 10 9 1 140°
130° 10 9 1 130°
120° 10 8 2 120°
110° 10 8 2 110°
100° 10 7 2 100°
90° 10 7 2 90°
80° 8 5 3 80°
70° 7 4 3 70°
60° 7 3 3 60°
50° 5 2 3 50°
40° 5 2 3 40°
30° 5 1 4 30°
20° 5 1 7 20°
10° 7 1 6 10°
Table 9.11.1c continued on following page.

132
Table 9.11.1c (continued)
Direction Ankylosis Loss of adduction Loss of abduction Direction

Abduction %WPI %WPI %WPI Abduction
0° 8 1 7 0°
10° 9 1 8 10°
20° 10 1 9 20°
30° 10 1 10 30°
40° 10 0 10 40°
50° 11 0 11 50°
Adduction Adduction
133
9.12 UPPER EXTREMITY AMPUTATIONS
Total loss of hand function is equivalent to amputation of the whole hand and attracts a WPI rating of 54%.
Table 9.14: Upper extremity function must not be used for amputations.
Table 9.12.1: Upper extremity amputations
% WPI Criteria
54 Amputation of thumb and all fingers through metacarpals.
56 Amputation at wrist or between wrist and distal to bicipital insertion.
57 Amputation from distal to deltoid insertion to bicipital insertion.
Amputation of arm at deltoid insertion and proximally
60 or
Amputation at shoulder.
70 Forequarter amputation.
134
Table 9.12.2: Amputation of digits
%WPI
%WPI Thumb Fingers Index and Ring and
middle little
2 Tip of thumb excluding bone. Tip of finger excluding bone. 1 1
7 Through distal phalanx. Through distal phalanx. 3 2
11 Through IP joint. Through distal IP joint. 5 3
17 Through proximal phalanx. Through middle phalanx. 7 4
22 Through MP joint. Through proximal IP joint. 8 4
22 Through distal third of 1st metacarpal. Through proximal phalanx. 10 5
23 At or near the CMC joint. Through MP joint or metacarpal. 11 5
9.13 NEUROLOGICAL IMPAIRMENTS AFFECTING THE UPPER EXTREMITIES
Sensory impairments due to digital nerve lesions alone are assessed under Table 9.8.2a, Table 9.8.2b, Table 9.8.2c, and Table
9.8.2d (tables dealing with sensory losses in thumb and fingers, see page 119-120).
Care must be taken to avoid duplicating impairment assessments for digital nerve sensory impairment with assessments for
peripheral nerve sensory impairment. Assessments for digital nerve sensory impairment are assessed under Tables 9.8.2a, 9.8.2b,
9.8.2c, and 9.8.2d. Assessments for peripheral nerve sensory impairment are assessed under Tables 9.13.1, 9.13.2a, and
9.13.2b.
For sensory impairment in the same digit, WPI ratings obtained from Table 9.13.1, Table 9.13.2a, and Table 9.13.2b, must not be
combined with WPI ratings from Tables 9.8.2a, 9.8.2b, 9.8.2c, and 9.8.2d.
The grading system set out in Figure 9-D: Grading system (over page) is to be used with Table 9.13.1, Table 9.13.2a, and Table
9.13.2b.
135
Figure 9-D: Grading system
See note following Figure 9-D.
Sensory deficits or pain Motor function

Grading
criteria criteria
No sensation
0 or No contraction.
Severe pain that prevents all activity.
No protective sensibility with abnormal sensations
1 or A flicker.
Severe pain that prevents most activity.
Decreased protective sensibility with abnormal sensations
2 or Active movement with gravity eliminated.
Severe pain that prevents some activity.
Diminished light touch AND two-point discrimination with some
abnormal sensations
3 Active movement against gravity.
or
Slight pain that interferes with some activity.
Diminished light touch with or without minimal abnormal sensations
Active movement against gravity and
4 or
resistance.
Pain that is forgotten during activity.
Normal sensation
5 or Normal power.
No pain.
136
Note to Figure 9-D
1. Figure 9-D also appears in Section 9.6—Spinal nerve

root impairments and peripheral nerve injuries affecting
the lower extremities as Figure 9-C. It is repeated here for
ease of reference.
9.13.1 Cervical nerve root impairment
Use the appropriate section of Table 9.13.1, depending on

whether there is involvement of a single spinal nerve, the
brachial plexus, or combined nerve root impairment.
WPI ratings for sensory impairment should be combined with

those for motor impairment, using the combined values chart
(see Appendix 1). Table 9.13.1 must not be used in conjunction
with Table 9.15: Cervical spine where the same nerve is
assessed under that table.
The maximum WPI rating for one upper extremity is 60%. A WPI
of 60% may be awarded either:
> for complete brachial plexus sensory loss
> brachial plexus motor loss
but these cannot be combined to give a WPI rating greater than

60% for the one upper extremity.
137
Table 9.13.1: Cervical nerve root impairment
Single nerve involvement Single nerve involvement

Sensory impairment Motor impairment
Grading Grading
5 4 3 2 1 0 5 4 3 2 1 0
C5 0 1 1 2 3 3 0 2 7 11 15 18 C5
C6 0 1 2 4 5 5 0 4 8 13 18 21 C6
C7 0 1 1 2 3 3 0 4 8 13 18 21 C7
C8 0 1 1 2 3 3 0 5 11 16 23 27 C8
T1 0 1 1 2 3 3 0 2 5 7 10 12 T1
138
Brachial plexus involvement Brachial plexus involvement
or combined nerve root or combined nerve root
impairment impairment
Sensory impairment Motor impairment
Grading Grading
5 4 3 2 1 0 5 4 3 2 1 0
Nerves or nerve roots % WPI % WPI Nerves or nerve roots
Complete brachial plexus Complete brachial plexus
0 12 24 42 54 60 0 12 24 36 51 60
(C5 to T1 inclusive) (C5 to T1 inclusive)
Upper trunk of brachial Upper trunk of brachial
plexus 0 3 6 11 14 15 0 9 18 27 38 45 plexus
(C5, C6, Erb-Duchenne) (C5, C6, Erb-Duchenne)
Middle trunk of brachial Middle trunk of brachial
0 1 1 2 3 3 0 4 8 13 18 21
plexus (C7) blexus (C7)
Lower trunk of brachial Lower trunk of brachial
plexus plexus
0 2 5 8 11 12 0 8 17 25 36 42
(C8, T1, (C8, T1,
Déjerine-Klumpke) Déjerine-Klumpke)
139
9.13.2 Specific nerve lesions affecting the upper extremities
Only employees with an objectively verifiable diagnosis qualify

for a WPI rating under Table 9.13.2a and Table 9.13.2b (see
pages 140-141). The diagnosis is made not only on credible
and clinically logical symptoms but, more importantly, on the
presence of positive clinical findings and loss of function. The
diagnosis should be documented by electromyography as well
as sensory and motor nerve conduction studies. As noted under
the principles of assessment, the assessing medical practitioner
should not order additional investigations solely for assessment
purposes.
It is critical to understand that there is no correlation between

the severity of conduction delay on nerve conduction velocity
testing, and the severity of either symptoms or the WPI rating.
If available, surgical findings of evidence of nerve compression

and reactive hyperaemia upon nerve release can be used to
confirm the diagnosis.
obtained for sensory impairment should be combined with WPI
ratings for motor impairment.
A WPI rating under Tables 9.13.2a and 9.13.2b may be

combined (except where the same nerve is assessed) with WPI
ratings from Table 9.15: Cervical spine.
140
Table 9.13.2a: Specific nerve lesions affecting the upper extremities—sensory impairment
Grading
5 4 3 2 1 0
Nerve % WPI
Axillary 0 1 1 2 3 3
Medial antebrachial cutaneous 0 1 1 2 3 3
Medial brachial cutaneous 0 1 1 2 3 3
Median nerve (above mid forearm) 0 5 9 16 21 23
Median nerve (below mid forearm) 0 5 9 16 21 23
Radial palmar digital of thumb 0 1 2 3 4 4
Ulnar palmar digital of thumb 0 1 3 5 6 7
Radial palmar digital of index finger 0 1 1 2 3 3
Ulnar palmar digital of index finger 0 0 1 1 2 2
Radial palmar digital of middle finger 0 1 1 2 3 3
Ulnar palmar digital of middle finger 0 0 1 1 2 2
Radial palmar digital of ring finger 0 0 1 1 2 2
Musculocutaneous 0 1 1 2 3 3
Radial (including loss of triceps function) 0 1 1 2 3 3
Radial (at elbow with sparing of triceps) 0 1 1 2 3 3
Suprascapular 0 1 1 2 3 3
Ulnar (above mid forearm) 0 1 2 3 4 4
Ulnar (below mid forearm) 0 1 2 3 4 4
Ulnar palmar digital of ring finger 0 0 0 1 1 1
Radial palmar digital of little finger 0 0 0 1 1 1
Ulnar palmar digital of little finger 0 0 1 1 2 2
141
Table 9.13.2b: Specific nerve lesions affecting the upper extremities—motor impairment
Grading
5 4 3 2 1 0
Nerve % WPI
Medial and lateral pectoral 0 1 1 2 3 3
Axillary 0 4 8 13 18 21
Dorsal scapular 0 1 1 2 3 3
Long thoracic 0 2 4 5 8 9
Median nerve (above mid forearm) 0 5 10 16 22 26
Median nerve (anterior interosseous branch) 0 2 4 5 8 9
Median nerve (below mid forearm) 0 1 2 4 5 6
Musculocutaneous 0 3 6 9 13 15
Radial (including loss of triceps function) 0 5 10 15 21 25
Radial (at elbow with sparing of triceps) 0 4 8 13 18 21
Subscapulars (upper and lower) 0 1 1 2 3 3
Suprascapular (upper and lower) 0 2 4 6 9 10
Thoracodorsal 0 1 2 4 5 6
Ulnar (above mid forearm) 0 6 11 17 24 28
Ulnar (below mid forearm) 0 4 8 13 18 21
142
9.13.3 Complex regional pain syndromes Since a subjective complaint of pain is the hallmark of these
conditions, and many of the associated physical signs and
Complex regional pain syndromes (CRPS) include reflex
radiographic findings can be the result of disuse, the differential
sympathetic dystrophy (CRPS I), and causalgia (CRPS II). The
diagnosis is extensive; it includes somatoform pain disorder,
hallmark of these syndromes is a characteristic burning pain
somatoform conversion disorder, factitious disorder, and
that is present without stimulation or movement, that occurs
malingering. Consequently, the approach to the diagnosis of
beyond the territory of a single peripheral nerve, and that is
these syndromes should be conservative and based on objective
disproportionate to the inciting event. The pain is associated
findings.
with specific clinical findings, including signs of vasomotor and
sudomotor dysfunction and, later, trophic changes of all tissues The criteria listed in Figure 9-E predicate a diagnosis of CRPS
from skin to bone. upon a preponderance of objective findings that can be identified
during a standard physical examination and demonstrated by
Sympathetic nervous system dysfunction was thought to be
radiographic techniques. At least eight of these findings must be
involved in the generation of the symptoms and signs; hence,
present concurrently for a diagnosis of CRPS. Signs are objective
the term reflex sympathetic dystrophy (RSD). Causalgia was
evidence of disease perceptible to the examiner, as opposed to
considered similar to RSD except, unlike RSD, it followed a
symptoms, which are subjective sensations of the individual.
lesion of a peripheral nerve, either of a major mixed nerve in
the proximal extremity (major causalgia) or of a purely sensory Use the methodology on page 144 to determine impairment.
branch more distally (minor causalgia). A recent reconsideration Use either steps in CRPS I (RSD) impairment determination
of these syndromes has generated new terminology and ideas or steps in CRPS II (causalgia) impairment determination as
concerning the underlying pathophysiology. The International appropriate. Only one of the methodologies may be used and
Association for the Study of Pain has proposed the term complex the impairment rating from one of the two methodologies may
regional pain syndromes, which has replaced the term RSD not be combined with a rating from the other methodology.
with CRPS I and causalgia with CRPS II. The most important
The impairment rating method described for sensory deficits due
difference from earlier opinions is that sympathetic dysfunction
to lesions of digital nerves is not applied in CRPS.
is not assumed to be the underlying basis for the symptoms and
signs of CRPS. It is felt that sympathetically maintained pain is
not an essential component of CRPS, as it may be present in a
variety of painful conditions, including or independent of CRPS.
Contrary to previous suggestions, regional sympathetic blockade

has no role in the diagnosis of CRPS.
143
Figure 9-E: Objective diagnostic criteria for CRPS (RSD and Notes to Figure 9-E
causalgia)
1. Modified and adapted from Ensalada LH, ‘Complex
Local clinical signs regional pain syndrome’, in Brigham CR, ed, The Guides
Casebook, Chicago, Ill: American Medical Association,
Vasomotor changes: 1999, 14.
> Skin colour: mottled or cyanotic
Figure 9-F: Impairment grading for CRPS
> Skin temperature: cool
> Oedema CRPS I & II Sensory deficits and pain
Sudomotor changes: % of whole person
Grade (see Fig 9-D)
impairment
> Skin dry or overly moist
5 0
Trophic changes:
4 1-15
> Skin texture: smooth, nonelastic
3 16-36
> Soft tissue atrophy: especially in fingertips
2 37-48
> Joint stiffness and decreased passive motion
1 49-59
> Nail changes: blemished, curved, talonlike
0 60
> Hair growth changes: fall out, longer, finer
Radiographic signs
> Radiographs: trophic bone changes, osteoporosis
> Bone scan: findings consistent with CRPS
Interpretation
≥ 8 Probable CRPS
< 8 No CRPS
144
Steps in CRPS I (RSD) impairment determination Steps in CRPS II (causalgia) impairment determination
In CRPS I, neither the initiating causative factor nor the In CRPS II, a specific sensory or mixed nerve structure is
symptoms involve a specific peripheral nerve structure or involved. If the diagnostic test in Figure 9-E is satisfied, the
territory. If the diagnostic test in Figure 9-E is satisfied, the impairment assessment is derived as follows.
impairment assessment is derived as follows.
Assess the WPI for the affected upper extremity
Assess the WPI for the affected upper extremity Step 1 resulting from the loss of motion of each affected
Step 1 resulting from loss of motion of each affected joint joint using Tables 9.8 to 9.11 as appropriate.
using Tables 9.8 to 9.11 as appropriate.
Assess the appropriate percentage impairment of
Assess the appropriate percentage impairment of the the affected extremity resulting from sensory deficits
affected extremity resulting from sensory deficits and and pain of the injured nerve(s) according to the
pain according to the grade that best describes the grade that best describes the severity of interference
severity of interference with activities as described Step 2 with activities as described in Figure 9-D. Use
in Figure 9-D (page 104). Use clinical judgment clinical judgment to select the appropriate severity
Step 2 to select the appropriate severity grade from Figure grade from Figure 9-D and determine the WPI % for
9-D and the appropriate percentage from within the relevant nerve(s) from Table 9.13.2a..
the range for each grade shown in Figure 9-F and The maximum value is not automatically applied.
explain the reasons for that selection.
Assess the appropriate percentage impairment of
The maximum value is not automatically applied.
the affected extremity resulting from motor deficits
Combine the impairment rating for sensory deficits and loss of power of the injured nerve(s) according
Step 3 and pain obtained from Step 2 with the rating to the grade that best describes the severity of
obtained from Step 1. Step 3 interference with as described in Figure 9-D. Use
clinical judgment to select the appropriate severity
In contrast to CRPS II, impairment values for sensory and motor grade from Figure 9-D determine the WPI% for the
deficits of a specific nerve structure cannot be applied. relevant nerve(s) from Table 9.13.2b.
Combine the impairment ratings for sensory deficits
and pain (Step 2), and for motor deficits and loss
Step 4 of power (Step 3), with the rating obtained from
Step 1. The maximum WPI for the affected extremity
is 60%.
145
9.14 UPPER EXTREMITY FUNCTION Table 9.14 should be used only to assess impairment from
objectively identified orthopaedic or neurological conditions
Before using Table 9.14 the medical assessor should read the
arising in, and affecting, the upper extremities.
instructions (see Part II—Introduction, see page 110) preceding
the specific joint impairment tables (Tables 9.8–9.11). Table While it is true that disuse secondary to pain may produce
9.14 is used strictly in accordance with those instructions. In secondary dysfunction of the upper extremities, this must not be
particular, Table 9.14 cannot be used where an assessment can assessed using Table 9.14 unless this dysfunction is permanent
be made under one or more Table 9.9, 9.10 or 9.11 and there (that is, not likely to improve as a result of surgery, medication
is no radiologically demonstrated joint instability or arthritis or or other rehabilitative treatment) and there are objective clinical
arthroplasty. findings that cannot be validly assessed using other tables in
Chapter 9, Part II—The upper extremities.
Table 9.14 is an alternative table, which may be used instead
of the specific orthopaedic or neurological table or tables. It Table 9.14 must not be used for assessment of amputations.
is important to note that Table 9.14 assesses the function of
Where one limb only is affected, regardless of the number of
the entire upper extremity. Consequently, for the purposes of
impairments found in that limb, the limb should be assessed
ascertaining the most beneficial WPI rating for the same upper
using the relevant tables other than 9.14 and all impairments
extremity, any assessment under Table 9.14 for a single upper
combined using the combined values table (see Appendix 1).
extremity may be compared only with the total or combined
The combined impairment rating should then be compared with
impairment obtained after using other tables in Chapter 9, Part
the rating taken from the relevant (non-dominant or dominant)
II—The upper extremities.
column in 9.14 and the higher rating obtained from the two
For the purposes of ascertaining the most beneficial WPI rating, methods used to determine WPI.
Table 9.14 may not be compared with single impairments under
Where both limbs are affected, each limb should be assessed
the other tables, unless there are no other impairments affecting
using the tables other than 9.14 and all impairments in both
the upper extremities.
limbs combined using the combined values table. The combined
At least one major criterion, and at least two minor criteria impairment rating should then be compared with the rating taken
(where listed), must be satisfied for a WPI rating to be assigned from the ‘both extremities’ column in Table 9.14 and the higher
under Table 9.14. Where possible, the major criteria should be rating obtained from the two methods used to determine WPI.
assessed on the basis of neurological examination of motor
Table 9.14 may be used to assess upper extremity impairment
strength, co-ordination and dexterity. Where possible, functional
arising as a result of spinal cord damage. Use the special
activities should be assessed by observation of the specified
procedure set out in the introduction to Part III of this chapter.
activities.
Table 9.14 is not to be used to assess upper extremity
146
impairment arising as a result of nerve root compression, or other neurological sequelae of cervical spinal conditions. These should
be assessed under Table 9.13.1, Table 9.13.2a and Table 9.13.2b (tables dealing with neurological impairments affecting the upper
extremities, see pages 137-141).
Table 9.14: Upper extremity function
% WPI % WPI % WPI

Non-dominant Dominant Both (at least one required) (at least two required where listed)
extremity extremity extremities
Writes 2 A4 pages or more at one time.
Normal digital dexterity. Can lift more than 13 kilograms (males).
0 0 0 No limitations in use of Can lift more than 9 kilograms (females).
extremity for personal
care. Able to lace shoes easily.
Joins paper clips without difficulty.
Minor loss of digital Rests after writing an A4 page.

dexterity. Cannot lift more than 13 kilograms (males).
3 5 10 Minor limitations in Cannot lift more than 9 kilograms (females).
use of extremity for Finds it difficult to do up shoelaces.
personal care. Fumbles when joining paper clips.
Moderate loss of digital Rests after writing half an A4 page.

dexterity. Cannot lift more than 4.5 kilograms.
10 10 20 Moderate limitations Cannot do up shoelaces.
in use of extremity for Cannot join paperclips.
personal care. Dresses slowly unassisted.
Rests after writing 50 words or less.
Major loss of digital Cannot lift more than 1.5 kilograms.
dexterity.
15 20 35 Cannot put on a tie or belt.
Major restrictions in
personal care. Needs assistance to cut up food.
Needs some assistance to dress.

147
% WPI % WPI % WPI

Non-dominant Dominant Both (at least one required) (at least two required where listed)
extremity extremity extremities
Little useful digital co- Rests after writing 10 words or less.

ordination. Cannot lift more than 0.5 kilograms.
25 30 50 Severely limited use of Constantly drops light objects (eg, cups).
extremity for personal Unable to cut up food.
care. Needs extensive assistance to dress.
No co-ordination of Unable to sign name.

digits. Constantly needs a splint to write or eat.
30 40 60 Severely limited use of Unable to lift light objects.
extremity for personal Needs food placed in mouth to eat.
care. Unable to dress without assistance.
Minimal extremity
movement against Cannot use extremity to eat.
40 50 70 gravity. Cannot bring a pen to paper.
Cannot use extremity Cannot raise extremity to assist dressing.
for personal care.
Unable to use upper
60 60 84
extremity at all.
148
PART III—THE SPINE
PART III—INTRODUCTION
Assess (where applicable):
The medical examiner should: 1.1. Lower limb impairment using Table 9.7
> obtain a comprehensive, accurate medical history and 1.2. Upper limb impairment using Table 9.14
review all relevant available records
1.3. Bladder/urological dysfunction using Table
> include in the assessment report a comprehensive 12.7: Neurological impairment of the urinary
description of current symptoms and their relationship to system (see Chapter 12—The neurological
daily activities, detailed findings on physical examination, system)
and all findings of relevant diagnostic and ancillary tests 1.4. Anorectal dysfunction using Table 12.8:
Neurological impairment of the anorectal
> indicate how the impairment assessment was calculated by Step 1 system (see Chapter 12—The neurological
reference to the relevant tables. system)
For the same condition, WPI ratings from Table 9.7: Lower 1.5. Sexual dysfunction using Table 12.9:
extremity function (see pages 108-109) and/or Table 9.14: Neurological impairment affecting sexual
Upper extremity function (see pages 146-147), are not normally function (see Chapter 12—The neurological
system)
combined with WPI ratings from Table 9.15: Cervical spine,
Table 9.16: Thoracic spine, or Table 9.17: Lumbar spine. 1.6. Respiratory dysfunction (for example, with
cervical spinal cord injuries) using Table 12.6:
However, the special procedure set out below applies where Neurological Impairment of the Respiratory
there is spinal cord injury with neurological sequelae (that is, System (see Chapter 12—The neurological
corticospinal tract involvement). system).
Combine the relevant impairments from 1-6 in Step
Step 2
1 above, as applicable.
Then combine the WPI from the above procedure
with the relevant WPI from Table 9.15, Table 9.16
Step 3
or Table 9.17 (diagnosis-related estimates) to
obtain the final WPI.
For injuries not involving spinal cord damage but resulting in

nerve root involvement/radiculopathy, use Table 9.15, Table
9.16 or Table 9.17, but do not combine with WPI ratings from
Tables 9.7 or 9.14.
149
Except where the same nerve is involved, WPI ratings from PART III—DEFINITIONS OF CLINICAL FINDINGS FOR DIAGNOSIS-
Table 9.15, Table 9.16 and Table 9.17 (where relevant) may be RELATED ESTIMATES IN ASSESSING SPINAL IMPAIRMENT
combined with WPI ratings under the following tables:
These definitions are taken from the American Medical
> Table 9.6.1, Table 9.6.2a, Table 9.6.2b (tables dealing Association’s Guides to the Evaluation of Permanent Impairment
with spinal nerve root impairments and peripheral nerve 5th edition 2001.
injuries affecting the lower extremities)
Alteration of motion segment integrity—motion segment
> Table 9.13.1, Table 9.13.2a and Table 9.13.2b (tables
alteration can be either loss of motion segment integrity
dealing with neurological impairments affecting the upper
(increased translational or angular motion), or decreased
extremities).
motion secondary to developmental fusion, fracture healing,
Where there is brachial plexus involvement, WPI ratings from healed infection, or surgical arthrodesis. An attempt at
Table 9.15: Cervical spine—diagnosis-related estimates may arthrodesis may not necessarily result in a solid fusion but
not be combined with WPI ratings under Table 9.13.1: Cervical may significantly limit motion at a motion segment. Motion
nerve root impairment. of the individual spine segments cannot be determined by a
physical examination but is evaluated with flexion and extension
Definitions of clinical findings for diagnosis-related estimates roentgenograms. When routine x-rays are normal and severe
in assessing spinal impairment are used when assessing trauma is absent, motion segment alteration is rare, and flexion
impairments of the spine under Table 9.15, Table 9.16 and and extension roentgenograms are indicated only if motion
Table 9.17. segment alteration is suspected from the individual’s history or
routine x-rays.
Asymmetry of spinal motion in one of the three principal planes

is sometimes caused by muscle spasm or guarding. That is,
if an individual attempts to flex the spine, he or she is unable
to do so moving symmetrically: rather, the head or trunk leans
to one side. To qualify as true asymmetric motion, the finding
must be reproducible and consistent, and the examiner must
be convinced that the individual is co-operative and giving full
effort.
150
Atrophy is measured with a tape measure at identical levels Muscle guarding is a contraction of muscle to minimise motion
on both limbs. For reasons of reproducibility, the difference in or agitation of the injured or diseased tissue. It is not true muscle
circumference should be 2cm or greater in the thigh, and 1cm or spasm because the contraction can be relaxed. In the lumbar
greater in the arm, forearm, or leg. spine, the contraction frequently results in loss of the normal
lumbar lordosis, and it may be associated with reproducible
Cauda equina syndrome is manifested by bowel or bladder
loss of spinal motion.
dysfunction, saddle anaesthesia and variable loss of motor and
sensory function in the lower extremities. Individuals with cauda Muscle spasm is a sudden, involuntary contraction of a muscle
equina syndrome usually have loss of sphincter tone on rectal or group of muscles. Paravertebral muscle spasm is common
examination and diminished or absent bladder, bowel, and after acute spinal injury but is rare in chronic back pain. It is
lower limb reflexes. occasionally visible as a contracted paraspinal muscle but is
more often diagnosed by palpation (a hard muscle).
Electrodiagnostic verification of radiculopathy—unequivocal
electrodiagnostic evidence of acute nerve root pathology To differentiate true muscle spasm from voluntary muscle
includes the presence of multiple positive sharp waves or contraction, the individual should not be able to relax the
fibrillation potentials in muscles innervated by one nerve root. contractions. The spasm should be present standing, as well as
However, the quality of the person performing and interpreting in the supine position, and frequently causes a scoliosis. The
the study is critical. Electromyography should be performed physician can sometimes differentiate spasm from voluntary
only by a physician qualified through education, training, and contraction by asking the individual to place all his or her
experience in these procedures. Electromyography does not weight first on one foot, and then the other, while the physician
detect all compressive radiculopathies and cannot determine gently palpates the paraspinous muscles. With this manoeuvre,
the cause of the nerve root pathology. On the other hand, the individual normally relaxes the paraspinal muscles on the
electromyography can detect non-compressive radiculopathies weight-bearing side. If the examiner witnesses this relaxation, it
which are not identified by imaging studies. usually means that true muscle spasm is not present.
Loss of motion segment integrity is defined as an anteroposterior Non-verifiable radicular root pain is pain that is in the
motion of one vertebra over another that is greater than 3.5mm distribution of a nerve root but has no identifiable origin (that is,
in the cervical spine, greater than 2.5mm in the thoracic spine, there are no objective physical, imaging, or electromyographic
and greater than 4.5mm in the lumbar spine. Alternatively, it is abnormal findings).
defined as a difference in the angular motion of two adjacent
motion segments greater than 15° at L1-2, L2-3 and L3-4,
greater than 20° at L4-5 and greater than 25° at L5-S1. In the
cervical spine, it is also defined as motion at one level that is
more than 11° greater than at either adjacent level.
151
Radiculopathy is significant alteration in the function of a nerve PART III—MULTI-LEVEL FRACTURES INVOLVING THE SPINAL
root or nerve roots, and is usually caused by pressure on one CANAL
or several nerve roots. The diagnosis requires a dermatomal
For multiple fractures involving the spinal canal on more than
distribution of pain, numbness, and/or paraesthesia. A root
one level, as distinct from the spinous processes or facet joints,
tension sign is usually positive. A diagnosis of herniated
the assessment made under Tables 9.15, 9.16 or 9.17 is to be
disc must be substantiated by an appropriate finding on an
adjusted as follows:
imaging study. The presence of findings on an imaging study is
insufficient to make the diagnosis of radiculopathy. There must > where there are multi-level fractures but no associated
also be clinical evidence as described above. neurological compromise:
– increase the assessment under Tables 9.15, 9.16 or
Reflexes may be normal, increased, reduced, or absent. For
9.17 by one level
reflex abnormalities to be considered valid, the involved and
normal limb(s) should show marked asymmetry between arms > where there are multi-level fractures with neurological
or legs on repeated testing. Once lost because of previous compromise:
radiculopathy, a reflex rarely returns. Abnormal reflexes such
– increase the assessment under Tables 9.15, 9.16 or
as Babinski signs or clonus may be signs of corticospinal tract
9.17 by two levels.
involvement.
The adjustment, by one or two levels, as applicable, may be
Urodynamic tests—cystometrograms are useful in individuals
made only once under each table.
where a cauda equina syndrome is possible but not certain. A
normal cystometrogram makes the presence of a nerve-related The adjusted WPI assessment may not exceed the maximum
bladder dysfunction unlikely. Occasionally, more extensive WPI rating available in each individual table.
urodynamic testing is necessary.
Weakness and loss of sensation—to be valid, the sensory

findings must be in a strict anatomical distribution (that is,
follow dermatomal patterns). Motor findings should also be
consistent with the affected nerve structure(s). Significant, long-
standing weakness is usually accompanied by atrophy.
152
9.15 CERVICAL SPINE—DIAGNOSIS-RELATED ESTIMATES
Table 9.15: Cervical spine—diagnosis-related estimates
% WPI Criteria
No significant clinical findings, no muscular guarding, no documented neurological impairment, no significant loss of
motion segment integrity, no other indication of impairment related to injury or illness
0
or
No fractures.
Clinical history and examination findings compatible with specific injury. Findings may include: muscle guarding or
spasm; asymmetric loss of range of motion or nonverifiable radicular complaints defined as complaints of radicular
pain without objective findings.
No alteration of structural integrity
or
Clinically significant radiculopathy and radiologically demonstrated disc herniation consistent with the radiculopathy
8 (improved following non-operative treatment)
or
Fractures:
> Compression fracture of one vertebral body of less than 25%
> Posterior element fracture without dislocation—healed without loss of structural integrity or radiculopathy
> Spinous or transverse process fracture with displacement.

153
% WPI Criteria
Significant signs of radiculopathy, such as pain and/or sensory loss in a dermatomal distribution, loss or alteration of
relevant reflex(es), loss of muscle strength, or unilateral atrophy compared with the unaffected side, measured at the
same distance above or below the elbow: the neurological impairment may be verified by electrodiagnostic findings
or
Clinically significant radiculopathy and radiologically verified disc herniation consistent with the radiculopathy, or with
improved radiculopathy following surgery
or
10 - 18 Fractures:
> Compression fracture of one vertebral body of 25% to 50%—healed without loss of structural integrity, with or
without radiculopathy
> Posterior element fracture with displacement disrupting the spinal canal—healed without loss of structural integrity,
with or without radiculopathy.
Note: In the case of fractures, differentiation from a congenital or developmental condition should be accomplished,
if possible, by examining pre-injury roentgenograms, if available, or by a bone scan performed after the onset of the
condition.
Alteration of motion segment integrity (at least 3.5mm of translation of one vertebra on another or angular motion of
more than 11º greater than at each adjacent level)
or
Bilateral or multilevel radiculopathy with radiologically verified disc herniation consistent with the radiculopathy
28 or
Loss of motion of a motion segment due to a developmental fusion or successful or unsuccessful attempt at surgical
arthrodesis
or
Compression fracture of one vertebral body of more than 50% without residual neural compromise.

154
% WPI Criteria
Significant upper extremity impairment requiring the use of upper extremity external functional or adaptive device(s);
There may be total neurological loss at a single level or severe, multilevel neurological dysfunction
38 or
Structural compromise of the spinal canal with severe upper extremity motor and sensory deficits but without lower
extremity involvement.
Notes to Table 9.15

9.16 THORACIC SPINE—DIAGNOSIS-RELATED ESTIMATES
Table 9.16: Thoracic spine—diagnosis-related estimates
% WPI Criteria
No significant clinical findings, no muscular guarding, no documented neurological impairment, no significant loss of
motion segment integrity, no other indication of impairment related to injury or illness
0
or
No fractures.
History and examination findings compatible with a specific injury or illness. Findings may include: significant muscle
guarding or spasm; asymmetric loss of range of motion (dysmetria); or non verifiable radicular complaints, defined as
complaints of radicular pain without objective findings.
No alteration of motion segment integrity
or
Herniated disc at the level and on the side that would be expected from objective clinical findings, but without radicular
8 signs following conservative treatment
or
Fractures:
> Posterior element fracture without dislocation—healed without alteration of motion segment integrity or radiculopathy
> Spinous or transverse process fracture with displacement, but without a vertebral body fracture.
155
% WPI Criteria
Ongoing neurological impairment of the lower extremity related to a thoracolumbar injury, documented by alteration of
motor and sensory functions, altered reflexes, or findings of unilateral atrophy above or below the knee related to no
other condition, or verified by electrodiagnostic testing
or
Clinically significant radiculopathy and radiologically verified disc herniation consistent with the radiculopathy, or with
improved radiculopathy following surgery
10 - 18 or
Fractures:
> Compression fracture of one vertebral body of 25% to 50%—healed without alteration of structural integrity
> Posterior element fracture with mild displacement disrupting the canal—healed without alteration of structural
integrity.
Note: Differentiation from a congenital or developmental condition should be accomplished, if possible, by examining
pre-injury roentgenograms, if available, or by a bone scan performed after the onset of the condition.
Alteration of motion segment integrity (at least 2.5mm translation of one vertebra on another)
or
23 Bilateral or multilevel radiculopathy with radiologically verified disc herniation consistent with the radiculopathy
or
Compression fracture of one vertebral body of more than 50% without residual neural compromise
Significant signs of radiculopathy, such as dermatomal pain and/or in a dermatomal distribution, sensory loss, loss
of relevant reflex(es), loss of muscle strength or measured unilateral atrophy above or below the knee compared to
measurements on the contralateral side at the same location (may be verified by electrodiagnostic findings)
and
28 Alteration of motion segment integrity (at least 2.5mm translation of one vertebra on another)
or
Compression fracture of one vertebral body by more than 50% with neural motor compromise, but not bilateral
involvement. In that instance, refer notes concerning corticospinal tract impairment evaluation (see page 148, Part III—
Introduction).
Notes to Table 9.16

156
9.17 LUMBAR SPINE—DIAGNOSIS-RELATED ESTIMATES
Table 9.17: Lumbar spine—diagnosis-related estimates
% WPI Criteria
No significant clinical findings, no observed muscle guarding or spasm, no documented neurological impairment, no
documented alteration in structural
0
or
No fractures.
Clinical history and examination findings compatible with a specific injury. Findings may include: significant muscle
guarding or spasm; asymmetric loss of range of motion; or nonverifiable radicular complaints, defined as complaints of
radicular pain without objective findings.
No alteration of the structural integrity and no significant radiculopathy
or
Prior clinically significant radiculopathy and radiologically demonstrated disc herniation, consistent with the
radiculopathy, but radiculopathy no longer present following conservative treatment
8
or
Fractures:
> Posterior element fracture without dislocation (not developmental spondylolysis) that has healed without alteration of
motion segment integrity
> Spinous or transverse process fracture with displacement without a vertebral body fracture, with no disruption of the
spinal canal.

157
% WPI Criteria
Significant signs of radiculopathy, such as dermatomal pain and/or in a dermatomal distribution, sensory loss,
alteration of relevant reflex(es), loss of muscle strength or measured unilateral atrophy above or below the knee
compared to measurements on the contralateral side at the same location (may be verified by electrodiagnostic
findings)
or
History of a herniated disc at the level and on the side consistent with objective clinical findings, associated with
10 - 13 radiculopathy, or employees who have had surgery for radiculopathy but are now asymptomatic
or
Fractures:
> Compression fracture of one vertebral body of 25% to 50%—healed without alteration of structural integrity
> Posterior element fracture with displacement disrupting the spinal canal —healed without alteration of structural
integrity.
Loss of motion segment integrity (at least 4.5mm of translation of one vertebra on another, or angular motion greater
than 15º at L1-2, L2-3, and L3-4, greater than 20º at L4-5, and greater than 25º at L5-S1). May have complete, or
near complete, loss of motion of a motion segment due to developmental fusion, or successful or unsuccessful attempt
23 at surgical arthrodesis
or
Compression fracture of one vertebral body of more than 50%, without residual neurological compromise.
Both radiculopathy and loss of motion segment integrity are present, with significant lower extremity impairment
indicated by atrophy or loss of reflex(es), pain, and/or sensory changes within an anatomic distribution (dermatomal),
verified by electrodiagnostic findings
and
28
at least 4.5mm of translation of one vertebra on another or angular motion greater than 15º at L1-2, L2-3, and L3-4,
greater than 20º at L4-5, and greater than 25º at L5-S1
or
Compression fracture of one vertebral body of more than 50%, with unilateral neurological compromise.
Notes to Table 9.17

158
9.18 FRACTURES OF THE PELVIS
A WPI rating from Table 9.18 may be combined with WPI ratings from Table 9.15: Cervical spine, Table 9.16: Thoracic spine, and
Table 9.17: Lumbar spine.
Table 9.18: Fractures of the pelvis

Healed fracture:
> without displacement or residual signs
> of one or both rami with displacement but without residual signs
0
> of ischium or ilium with displacement but without residual signs
> of coccyx with displacement but without residual signs
> of one pubic ramus with displacement, deformity and residual signs.
2 Healed fracture of ilium with displacement, deformity and residual signs.
Healed fracture of:
> sacrum with displacement but without residual signs
> symphysis pubis without separation and without residual signs
5
> both pubic rami with displacement, deformity and residual signs.
Non-union of coccyx fracture.
Excision of coccyx.
Healed fracture of:
10 > ischium with displacement of 2.5cm or more, deformity and residual signs
> sacrum involving sacro-iliac joint.
15 Healed fracture of symphysis pubis with separation or displacement.
Evaluate in
accordance with Fracture involving acetabulum.
Table 9.4
159
CHAPTER 10—THE URINARY SYSTEM
10.0 INTRODUCTION 160

10.1 THE UPPER URINARY TRACT 160
10.2 URINARY DIVERSION 162
10.3 LOWER URINARY TRACT 162
160
10.0 INTRODUCTION 10.1 THE UPPER URINARY TRACT
In conducting an assessment, the assessor must have regard The upper urinary tract comprises the kidney and ureters.
to the Principles of Assessment (see pages 9-13) and the
Upper urinary tract dysfunction may be indicated by symptoms
definitions contained in the Glossary (see page 14).
and signs including:
Impairments assessed under Chapter 10 include those caused
> changes in urination
by secondary conditions accompanying an endocrine system
condition. An impairment assessed under Chapter 3 – The > oedema
Endocrine System (see page 37) should be combined with > decreased physical stamina
those resulting from the secondary conditions assessed under
> appetite and weight loss
Chapter 10.
> anaemia
> uraemia
> loin, abdominal or costovertebral angle pain
> haematuria
> rigours/chills and fever
> hypertension or its complications
> abnormalities in the appearance of the urine or its sediment
> biochemical blood changes.
Especially in its early stages, renal disease may only become

evident with laboratory findings.
Continuous medical treatment includes drug or dietary therapy.
Renal replacement therapy includes peritoneal or haemodialysis

and renal transplantation.
161
Table 10.1: The upper urinary tract
Criteria (criteria in both Category A and Category B must be satisfied if present)

Category A Category B
% WPI Creatinine clearance Other symptom(s)
And intermittent symptoms and signs of upper urinary tract dysfunction are present but do not
0 >62 ml/min
require continuous treatment or surveillance.
And intermittent symptoms and signs of upper urinary tract dysfunction are present but do not
5 52-62 ml/min
require continuous treatment or surveillance.
10 not applicable Loss of one kidney or one kidney not functioning.
And intermittent symptoms and signs of upper urinary tract dysfunction are present and require
15 >62 ml/min
continuous surveillance and frequent treatment.
And symptoms and signs of upper urinary tract dysfunction are present and require continuous
20 52-62 ml/min
surveillance and frequent treatment.
Successful renal transplantation results in marked renal function improvement (regardless of
25 not applicable
creatinine clearance level).
And symptoms and signs of upper urinary tract dysfunction are present and require continuous
30 43-52 ml/min
surveillance and frequent treatment.
40 28-42 ml/min Not applicable
AND symptoms and signs of upper urinary tract dysfunction are present and are not completely
50 43-52 ml/min
controlled by surgical or continuous medical treatment.
60 <28 ml/min Not applicable
And symptoms and signs of upper urinary tract dysfunction are present and are not controlled
70 28-42 ml/min
by surgical or continuous treatment.
And symptoms and signs of upper urinary tract dysfunction are present and are not controlled
80 <28 ml/min
by surgical or continuous treatment.
90 <14 ml/min And renal replacement therapy.
95 <14 ml/min And metabolic coma from renal failure.
162
10.2 URINARY DIVERSION If:
Using the combined values chart (see Appendix 1), WPI ratings > several impairments of the urinary system are present; and
derived from Table 10.2 below may be combined with WPI > there is an impairment of bladder function due to
ratings derived from Table 10.1 (on previous page). neurological causes
Table 10.2: Urinary diversion then:

> a WPI rating from Table 10.3 (except for bladder function)
% WPI Type of diversion may be combined with a WPI rating from Chapter 12—The
Ureterointestinal. neurological system.
10
Cutaneous ureterostomy. Symptoms and signs of bladder disorder include:
15 Nephrostomy. > urinary frequency
> dysuria
10.3 LOWER URINARY TRACT > strangury
The lower urinary tract comprises the bladder and urethra. > urinary incontinence
> urine retention
Table 10.3: Lower urinary tract is on the following page.
> haematuria
> pyuria
derived from Table 10.3 may be combined with WPI ratings
from Table 10.1—The upper urinary tract, and with WPI ratings > passage of urinary calculi
from Table 10.2: Urinary diversion. > a suprapubic mass.
Impairment in the lower urinary tract due to neurological causes, Signs and symptoms of urethra function impairment include:
as opposed to local lower urinary tract pathology, should be > dysuria
assessed under Table 12.7: Neurological impairment of the
> diminished urinary stream
urinary system (see Chapter 12—The neurological system).
> urinary retention
> incontinence
> extraneous or ectopic urinary openings
> periurethral masses
> diminished urethral calibre.
163
Table 10.3: Lower urinary tract
% WPI Criteria
Symptoms and signs of bladder or urethral disorder occurring 1-3 times a year and requiring intermittent treatment—
0
between episodes lower urinary tract function is normal.
Symptoms and signs of bladder or urethral disorder occurring 4-6 times a year and requiring intermittent treatment—
between episodes lower urinary tract function is normal
5
or
urethral stricture requiring dilation up to six times a year—between dilations there is normal urethral function.
Symptoms and signs of bladder disorder occurring 7-12 times a year and requiring intermittent treatment—between
episodes bladder function is normal
10 or
urethral stricture requiring dilation more than six times a year—between dilations there are significant periods of normal
urethral function.
Symptoms and signs of bladder disorder occurring more than 12 times a year and requiring intermittent treatment –
between episodes bladder function is normal
15
or
urethral fistula.
Symptoms and signs of bladder disorder requiring continuous treatment
or
good bladder reflex activity (that is, storage of urine) but no voluntary control over the reflex activity
20
or
urethral stricture requiring dilation more than six times a year—between dilations there are no significant periods of
normal urethral function.
Poor reflex bladder activity (that is, intermittent dribbling incontinence, stress incontinence or urge incontinence) and no
voluntary control over the incontinence
30
or
urethral dysfunction resulting in intermittent urine dribbling and loss of voluntary urinary control.
No reflex or voluntary control of bladder (that is, continuous dribbling incontinence)
40 or
urinary diversion with cystectomy.
164
CHAPTER 11—THE REPRODUCTIVE SYSTEM

11.1 MALE REPRODUCTIVE SYSTEM 165
11.1.1 Male reproductive organs—penis 166
11.1.2 Male reproductive organs—scrotum 166
11.1.3 Male reproductive organs—testes, epididymes and spermatic cords 168
11.1.4 Male reproductive organs—prostate and seminal vesicles 169
11.2 FEMALE REPRODUCTIVE SYSTEM 169

11.2.1 Female reproductive organs—vulva and vagina 170
11.2.2 Female reproductive organs—cervix and uterus 171
11.2.3 Female reproductive organs—fallopian tubes and ovaries 172

165
11.0 INTRODUCTION Tables 11.1.1, 11.1.2, 11.1.3, and 11.1.4 are not to be
used with respect to sexual dysfunction arising as a result
of neurological impairments rather than local reproductive
pathology. Where sexual dysfunction is the result of spinal
cord injury, use Table 9.6.1: Spinal nerve root impairment
affecting the lower extremity (see page 104, Chapter 9—The
11.1 MALE REPRODUCTIVE SYSTEM musculoskeletal system). Where sexual dysfunction is the result
of neurological disorder other than spinal nerve root impairment,
WPI ratings from Tables 11.1.1, 11.1.2, 11.1.3, and 11.1.4
use Table 12.9: Neurological impairment affecting sexual
may be combined, provided the total WPI rating for all
function (see page 193, Chapter 12—The neurological system).
conditions affecting ability to father children does not exceed
20%. Tables 11.1.1, 11.1.2, 11.1.3, and 11.1.4 are intended for
use only to assess impairment resulting from neurological
The WPI ratings in Tables 11.1.1, 11.1.2, 11.1.3 and 11.1.4
impairment, or local lesions of:
are applicable to 40–65 year old men.
> penis
Where the employee is outside this age group, the following
calculation should be made: > scrotum
> for men 39 years of age or younger, the combined WPI > testes
rating (from Tables 11.1.1, 11.1.2, 11.1.3 and 11.1.4) is > epididymes
increased by 50%
> spermatic cords
> men 66 years of age or older, the combined WPI rating
> prostate and/or seminal vesicles.
(from Tables 11.1.1, 11.1.2, 11.1.3 and 11.1.4) is
decreased by 50%. These tables can be used to assess impairment where
obstruction of the vascular supply of the penis and other male
For example, a 29 year old man with a combined maximum
organs occurs.
WPI of 20% of the male reproductive system would be rated as
suffering a 30% WPI: 20% WPI + (0.5 x 20%WPI) = 30% These tables are not intended for use where sexual function is
WPI. impaired for any other reason (for example, pain or depression).
166
11.1.1 Male reproductive organs—penis
Table 11.1.1: Male reproductive organs—penis
% WPI Criteria
0 Occasional interference with sexual function.
10 Sexual function possible but always with a degree of difficulty with erection, ejaculation and/or sensation.
15 Sexual function possible in that there is sufficient erection but sensation and/or ejaculation is absent.
20 No sexual function is possible.
11.1.2 Male reproductive organs—scrotum
Skin disorders such as dermatitis, or tinea, affecting the scrotal skin are assessed under Table 4.1: Skin disorders (see Chapter 4—
Disfigurement and skin disorders). Table 11.1.2 is not used to assess these conditions.
167
Table 11.1.2: Male reproductive organs—scrotum
% WPI Criteria
Symptoms and/or signs of scrotal loss or disease with no evidence of testicular malfunction, malposition or loss of
0
mobility.
Symptoms and/or signs of scrotal loss or disease with no evidence of testicular malfunction but with testicular
5
malposition or loss of mobility.
Total loss of scrotum
or
10
symptoms and signs of scrotal loss or disease with necessity for testes to be implanted elsewhere to preserve testicular
function.
Symptoms and signs of scrotal loss or disease with necessity for testes to be implanted elsewhere to preserve testicular
function
15
and
scrotal pain or discomfort present with physical activity.
Symptoms and signs of scrotal loss or disease unable to be controlled by treatment
20 and
scrotal pain severely limits physical activity.
168
11.1.3 Male reproductive organs—testes, epididymes and spermatic cords
Table 11.1.3: Male reproductive organs—testes, epididymes and spermatic cords
% WPI Criteria
Symptoms and signs of testicular, epididymal and/or spermatic cord dysfunction are present and there is anatomical
alteration
0
and
continuous treatment is not required and there are no seminal or hormonal abnormalities.
5 Loss of one testis
alteration
and
10
continuous or frequent treatment is required, or treatment is not possible
and
there are no seminal or hormonal abnormalities.
alteration
and
15
continuous or frequent treatment is required, or treatment is not possible
and
there is no detectable seminal or hormonal function.
20 Loss of both testes.
169
11.1.4 Male reproductive organs—prostate and seminal vesicles
Table 11.1.4: Male reproductive organs—prostate and seminal vesicles
% WPI Criteria
Symptoms and signs of prostate and/or seminal vesicle disease or dysfunction are present
and
0 there is anatomical alteration
and
continuous or very frequent treatment not required.
Frequent and severe symptoms of prostate and/or seminal vesicle disease or dysfunction are present
and
10 there is anatomical alteration
and
continuous or very frequent treatment not required.
15 Prostatectomy.
11.2 FEMALE REPRODUCTIVE SYSTEM
WPI ratings from Tables 11.2.1, 11.2.2 and 11.2.3 (see pages 170-173) may be combined. However, the total WPI rating for all
conditions affecting ability to conceive and be delivered of children may not exceed 30%.
Tables 11.2.1, 11.2.2, and 11.2.3 are not to be used with respect to sexual dysfunction arising as a result of neurological
impairments rather than local reproductive pathology. Where sexual dysfunction is the result of spinal cord injury, use Table 9.6.1:
Spinal nerve root impairment affecting the lower extremity (see Chapter 9—The musculoskeletal system). Where sexual dysfunction is
the result of neurological disorder other than spinal nerve root impairment, use Table 12.9: Neurological impairment affecting sexual
function (see Chapter 12—The neurological system).
170
11.2.1 Female reproductive organs—vulva and vagina
Table 11.2.1: Female reproductive organs—vulva and vagina
% WPI Criteria—pre-menopausal Criteria—post-menopausal

Symptoms and signs of disease or deformity of the vulva
and/or vagina are present Symptoms and signs of disease or deformity of the vulva
and/or vagina are present
and
and
continuous treatment is not required
0 continuous treatment is not required
and
and
sexual intercourse is possible
sexual intercourse is possible with or without considerable
and
difficulty.
the vagina is adequate for childbirth.
and/or vagina are present Symptoms and signs of disease or deformity of the vulva
and
and
continuous treatment is required
10 - 15 continuous treatment is required and may not control
and
symptoms
sexual intercourse is possible only with difficulty
and
and
sexual intercourse is not possible.
limited potential for vaginal delivery.
and
continuous treatment does not control symptoms
25
and
sexual intercourse is not possible
and
vaginal delivery is not possible.
Notes to Table 11.2.1

171
11.2.2 Female reproductive organs—cervix and uterus
Table 11.2.2: Female reproductive organs—cervix and uterus
See notes to Table 11.2.2 following the table.

Symptoms or signs of disease or deformity of cervix and/
or uterus present
and Cervical stenosis.
0
continuous treatment not required Anatomical loss of cervix and/or uterus.
or
cervical stenosis not requiring treatment.
Symptoms and signs of disease or deformity of cervix
and/or uterus present
5
and
continuous treatment required.
Symptoms and signs of disease or deformity of cervix Symptoms and signs of disease or deformity of the cervix
and/or uterus present and/or uterus present
10
and and
continuous treatment required. treatment does not give control.
15 Cervical stenosis requiring periodic treatment.
Symptoms and signs of disease or deformity of cervix
and/or uterus present
and
25
treatment does not control symptoms
or
complete cervical stenosis.
Total hysterectomy
30 and/or
amputation of cervix.
172
1. Hormone replacement therapy is not considered continuous treatment for the purposes of Table 11.2.2.
2. Oral contraception may be considered continuous treatment if pregnancy is contraindicated because of the cervical or uterine
lesion.
11.2.3 Female reproductive organs—fallopian tubes and ovaries
Table 11.2.3: Female reproductive organs—fallopian tubes and ovaries

Symptoms or signs of disease or deformity of the fallopian
Symptoms or signs of disease or deformity of the fallopian tubes or ovaries present
tubes or ovaries present
and
and
0 continuous treatment not required
continuous treatment not required
and or
no difficulties with conception or loss of one ovary. unilateral or bilateral loss of one or both fallopian tubes
and/or one or both ovaries.
tubes or ovaries present
and Symptoms or signs of disease or deformity of the fallopian
continuous treatment not required tubes or ovaries present
5
and and
conception possible with medical intervention continuous treatment required.
or
loss of one fallopian tube.
Table 11.2.3 continued on following page.

173
Table 11.2.3 (continued)

tubes or ovaries present Symptoms or signs of disease or deformity of the fallopian
and tubes or ovaries present
10 continuous treatment required and
and continuous treatment does not give control.
conception is possible although medical intervention may
be required.
Bilateral loss of both fallopian tubes
20 or
irreparable loss of patency of both fallopian tubes.
Loss of both ovaries
30 or
failure to produce ova despite treatment.
174
CHAPTER 12—THE NEUROLOGICAL SYSTEM

12.1 DISTURBANCES OF LEVELS OF CONSCIOUSNESS AND AWARENESS 178
12.1.1 Permanent disturbances of levels of consciousness and awareness 178
12.1.2 Epilepsy, seizures and convulsive disorders 178
12.1.3 Sleep and arousal disorders 179
12.2 IMPAIRMENT OF MEMORY, LEARNING, ABSTRACT REASONING AND PROBLEM

SOLVING ABILITY 180
12.3 COMMUNICATION IMPAIRMENTS—DYSPHASIA AND APHASIA 183
12.4 EMOTIONAL OR BEHAVIOURAL IMPAIRMENTS 184
12.5 CRANIAL NERVES 186
12.5.1 The olfactory nerve (I) 186
12.5.2 The optic nerve, the oculomotor and trochlear nerves and the abducens (II, III, IV and VI) 186
12.5.3 The trigeminal nerve (V) 186
12.5.4 The facial nerve (VII) 188
12.5.5 The auditory nerve (VIII) 188
12.5.6 The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII) 190
175
12.6 NEUROLOGICAL IMPAIRMENT OF THE RESPIRATORY SYSTEM 192
12.7 NEUROLOGICAL IMPAIRMENT OF THE URINARY SYSTEM 192
12.8 NEUROLOGICAL IMPAIRMENT OF THE ANORECTAL SYSTEM 193
12.9 NEUROLOGICAL IMPAIRMENT AFFECTING SEXUAL FUNCTION 193
176
12.0 INTRODUCTION The following procedure should be used in assessing cerebral
function.
to the principles of assessment (see pages 9-13) and the Determine whether disturbance is present in
definitions contained in the glossary (see page 14). the level of consciousness or awareness (Table
12.1.1, Table 12.1.2 and Table 12.1.3). This
The four categories of cerebral impairment are: Step 1 may be a permanent alteration or an intermittent
> disturbances of levels of consciousness or awareness (see alteration in consciousness, awareness or arousal.
Use the most applicable of Table 12.1.1, Table
Table 12.1.1, Table 12.1.2 and Table 12.1.3)
12.1.2 or Table 12.1.3.
> impairment of memory, learning, abstract reasoning and Evaluate mental status and highest integrative
problem solving ability (see Table 12.2) Step 2
functioning (Table 12.2).
> communication impairments (see Table 12.3.1 and Identify any difficulty with comprehension and the
Table 12.3.2) use of language (Table 12.3.1 and Table 12.3.2).
Step 3
Use the higher of the WPI ratings from these two
> emotional or behavioural impairments (see Table 12.4). tables.
WPI ratings from these four categories of cerebral impairment Evaluate any emotional or behavioural
may not be combined with each other. The highest WPI rating Step 4 disturbances, such as depression, that can modify
from these four categories is to be used. Unless otherwise cerebral function (Table 12.4).
indicated, the highest WPI rating may then be combined with: Identify the most severe cerebral impairment from
steps 1 to 4 above. Combine the most severe WPI
> a WPI rating from any other table or tables in Chapter 12
Step 5 rating with WPI ratings from any tables in Chapter
other than tables covering the first four categories 12 including and following Table 12.5.1, or with
> WPI ratings from tables in other chapters. WPI ratings from other chapters.
‘Activities of daily living’ are those that an employee needs to

perform to function in a non-specific environment (that is, to
live). Performance of activities of daily living is measured by
reference to primary biological and psychosocial function.
For the purposes of Chapter 12, activities of daily living are

those in Figure 12-A on the following page.
177
Activity Examples
Physical activity
Notes regarding station, gait and movement disorders
Station, gait and movement disorders:

> station and gait disorders affecting the lower extremities are to be assessed under Table 9.7: Lower extremity function (see
Chapter 9—Musculoskeletal system)
> movement disorders affecting the upper extremities are to be assessed under Table 9.14: Upper extremity function (see Chapter
9—Musculoskeletal system)
> except as provided for in the case of injury involving spinal cord damage, (see notes to Tables 9.15 – 9.17, Chapter 9—
Musculoskeletal system), station, gait and movement disorders may not be combined with any other WPI ratings from Chapter 9
for the same condition, but may be combined with other WPI ratings under Chapter 12.
178
12.1 DISTURBANCES OF LEVELS OF CONSCIOUSNESS AND AWARENESS
12.1.1 Permanent disturbances of levels of consciousness and awareness

Table 12.1.1 applies to stupor, coma, and permanent vegetative state. These conditions are assessed based on clinical findings on
neurological examination and relevant ancillary testing such as CT scan, MRI, SPECT, EEG, evoked potentials and vestibular testing.
Table 12.1.1: Permanent disturbances of levels of consciousness and awareness
% WPI Criteria
Mild persistent alteration of state of consciousness limiting ability to perform some activities requiring alertness but not
10 - 15
interfering with self care.
Moderate persistent alteration of state of consciousness limiting ability to perform most activities of daily living
30
including self care.
70 Semi-comatose state with complete dependence on others for self care and subsistence.
95 Persistent vegetative state or coma requiring total medical support in a specialised care facility.

12.1.2 Epilepsy, seizures and convulsive disorders

Table 12.1.2 is used for episodic neurological disorders of consciousness and awareness.
Table 12.1.2: Epilepsy, seizures and convulsive disorders
% WPI Criteria
Paroxysmal disorder with predictable characteristics but unpredictable occurrence and frequency and severity of
10
attacks which place some restrictions on activities of daily living and may constitute a risk to the employee.
Paroxysmal disorder with predictable characteristics but unpredictable occurrence and frequency and severity of
20
attacks which place many restrictions on activities of daily living and constitutes a risk to the employee or others.
Severe paroxysmal disorder of such frequency and severity that it limits activities of daily living to those that are
40
supervised or protected.
Severe, uncontrollable paroxysmal disorder of such severity that it totally restricts the employee’s daily activities—full
70
time care and supervision are required.
179
12.1.3 Sleep and arousal disorders
Arousal and sleep disorders include disorders related to:

> initiating and maintaining sleep, or inability to sleep
> excessive somnolence, including sleep-induced respiratory impairment
> sleep-wake schedules.
Central sleep apnoea should be assessed using Table 12.1.3 below. Obstructive sleep apnoea should be assessed using Table 2.4:
Whole person impairment derived from obstructive sleep apnoea score (see page 36, Chapter 2—The respiratory system).
Table 12.1.3: Sleep and arousal disorders
See notes to Table 12.1.3 immediately following the table.
% WPI Criteria
Reduced daytime alertness placing some restrictions on activities of daily living, performance of which might constitute
10
a risk to the employee.
Reduced daytime alertness placing many restrictions on activities of daily living and constituting a risk to the
20
employee.
Reduced daytime alertness of such severity that it limits activities of daily living to those that are supervised or
40
protected.
Severe reduction in daytime alertness which totally restricts the employee’s daily activities.
60
Full time care and supervision are required.
1. Supervision means the immediate presence of a suitable person, responsible in whole or in part for the care of the employee.
2. Suitable person means a person capable of responsibly caring for the employee in an appropriate way.
180
12.2 IMPAIRMENT OF MEMORY, LEARNING, ABSTRACT Find the row in Table 12.2 that exactly matches the respective
REASONING AND PROBLEM SOLVING ABILITY scores for CDR and memory. The WPI rating is shown in the first
column of that row.
WPI ratings in Table 12.2 reflect increasing levels of severity. To
satisfy particular WPI rating requirements, the majority of criteria
Table 12.2: Impairment of memory, learning, abstract
for each WPI rating should be present, as described in Figure
reasoning and problem solving ability
12-B (see following page).
The WPI ratings are incremental. In order to satisfy the criteria % WPI CDR Score Memory Score
for a particular degree of impairment, the employee must have 0 0 0
a greater degree of impairment than that described for the
3 0.5 0
preceding levels.
7 0.5 0.5
The clinical dementia rating (CDR) test for memory, abstract
10 0.5 1.0
reasoning and problem solving (Figure 12-B) should be
administered by a professional competent in the area. 15 1.0 0.5
The employee’s cognitive function for each category (memory, 20 1.0 1.0
orientation, judgement and problem solving, community affairs, 25 1.0 2.0
home and hobbies, personal care) is scored independently. For
30 2.0 1.0
the purposes of assessing impairment, memory is considered
the primary category. The other categories are secondary. 40 2.0 2.0
The following rules apply to scoring: 45 2.0 3.0
> if at least three secondary categories are given the same 55 3.0 2.0
numeric score as memory, then the clinical dementia rating 70 3.0 3.0
equals the memory score (CDR=M)
> if three or more of the secondary categories are given a
score greater than or less than that for memory, then CDR is
increased or decreased from M by one level as applicable
> however, if three secondary categories are scored one
side of M, and two are scored on the other side of M, then
CDR=M.
181
Figure 12-B: Clinical dementia rating (CDR)
From American Medical Association’s Guides to the Evaluation of Permanent Impairment 5th edition, 2001.
Impairment level and CDR score

(most of the criteria for a particular WPI rating should be present)
None Questionable Mild Moderate Severe
Category
0 0.5 1.0 2.0 3.0
Moderate memory Severe memory

Consistent slight loss;
loss; more marked
Memory No memory loss or forgetfulness; Severe memory
for recent events; only highly learned
slight inconsistent partial recollection loss; only
(M) defect interferes material retained;
forgetfulness. of events; ‘benign’ fragments remain.
with everyday new material
forgetfulness.
activities. rapidly lost.
Moderate
difficulty with time
Severe difficulty
relationships;
Fully oriented, with time
Orientation oriented for
except for slight relationships; Oriented to person
Fully oriented. place at
(O) difficulty with time usually disoriented only.
examination;may
relationships to time, often to
have geographic
place.
disorientation
elsewhere.
Solves everyday
Moderate difficulty Severely impaired
problems and
Slight impairment in handling in handling
Judgement and handles business
in solving problems, problems, Unable to make
problem solving and financial
problems, similarities and similarities and judgements or
affairs well;
(JPS) similarities and differences; social differences; social solve problems.
judgement good
differences. judgement usually judgement usually
in relation to past
maintained. impaired.
performance.
182
Impairment level and CDR score
(most of the criteria for a particular WPI rating should be present)
None Questionable Mild Moderate Severe
Category
0 0.5 1.0 2.0 3.0
No pretence of
Unable to function No pretence of
independent
Independent independently at independent
function outside
Community affairs function at these activities function outside
home;
usual level in Slight impairment although may still home;
(CA) be engaged in Appears too ill
job, shopping, in these activities. appears well
volunteer and some; to be taken to
enough to be taken
social groups. functions outside
appears normal to to functions outside
the employee’s
casual inspection. a family home.
family home.
Mild but definite
impairment of
function at home; Only simple chores
Life at home, Life at home, more difficult preserved;
Home and hobbies hobbies and hobbies and chores abandoned; No significant
(HH) intellectual interests intellectual interests very restricted function in home.
well maintained. slightly impaired. more complicated interests, poorly
hobbies and maintained.
interests
abandoned.
Requires Requires much

Personal care assistance in help with personal
Fully capable of Fully capable of care;
(PC) Needs prompting. dressing, hygiene,
self care. self care.
keeping of frequent
personal effects. incontinence.
Source: Morris JC, 1993, ‘The Clinical Dementia Rating (CDR): current version and scoring rules’, Neurology, 43(11): 2412-2414.
183
12.3 COMMUNICATION IMPAIRMENTS—DYSPHASIA AND Dysphasia is the most common diagnosis, since most
APHASIA individuals usually retain some ability to communicate. An
inability to understand language has a poorer prognosis than
Communication involves comprehension, understanding,
an inability to express language. Speech therapy is of little value
language, and effective interaction between and among
in the absence of comprehension; therefore, compensatory
individuals. Aphasia is a condition in which language function
techniques may not be learned when a receptive aphasia or
is defective or absent. It includes a lack of comprehension
dysphasia exists. Tests for dysphasia should be conducted after
with deficits in vision, hearing, and language (both spoken
it is established how confused or disoriented the individual is
and written), and also the inability to implement discernible
and which side of the brain is dominant for speech. Cognition
and appropriate language symbols by voice, action, writing or
should also be evaluated after dysphasia mechanisms have
pantomime. Dysphasia is a language impairment that is less
been excluded.
severe that aphasia (which literally means ‘no speech’) but
still is associated with a lesion in the dominant parietal lobe. Aphasia and dysphasia test batteries are frequently devised by
It presents as a communication problem due to receptive or the clinician and cover the following simple tasks: (1) listening
expressive dysphasia or a combination of the two. Inability to to spontaneous speech or responses to simple questions;
have a meaningful conversation because no nouns are used (2) pointing commands and questions that can be answered
is an example of dysphasia. Other common errors include ‘yes’ or ‘no’ to test comprehension; (3) repeating words and
errors of grammatical structure, word-finding difficulties, and phrases; (4) naming objects that have high-and-low frequency
word substitution. Dysphasia and aphasia are different from use; (5) reading comprehension and reading aloud (reading
dysarthria, which is imperfect articulation of speech due is related to educational achievement, which must be known
to disordered muscle control. Dysphonia is an impairment before interpreting reading comprehension and reading aloud
of sound production that causes difficulty speaking and results); and (6) writing and spelling. If comprehension is
understanding. Speech and communication impairments due relatively intact, the aphasia screening battery may be adequate
to non neurological primary problems are discussed in Chapter to place an individual in class 1 or 2. However, individuals with
11¬—Ear, nose, throat and related structures. dysphasia may score poorly on aphasia and dysphasia test
batteries while they demonstrate communicative competency for
activities of daily living. This communicative competency may
be measured by means of the communicative abilities in daily
living (CADL), in which non verbal communication is assessed.
Table 12.3 describes the criteria for rating impairment due to
aphasia or dysphasia.
184
Table 12.3: Criteria for rating impairment due to aphasia or Neurological conditions associated with changes in emotion and
dysphasia affect include:
> right hemisphere infarct and inappropriate jocularity
% WPI Criteria
> left hemisphere infarct and deep dejection, and dysphasia
Minimal disturbance in comprehension and
5
production of language symbols of daily living. > left-sided temporolimbic seizure foci and ideational
disorders
Moderate impairment in comprehension and
10
production of language symbols of daily living. > right-sided temporolimbic seizure foci and mood
disturbances.
Able to comprehend non verbal communication;
32 production of unintelligible or inappropriate The neuropsychiatric inventory (NPI) may be used to assess ‘no
language for daily activities. cognitive’ behavioural symptoms such as apathy, delusions,
Complete inability to communicate or dysphoria, agitation/aggression, euphoria, hallucinations,
50 irritability/lability, and aberrant motor behaviour (Cummings et
comprehend language symbols.
al, 1994).
12.4 EMOTIONAL OR BEHAVIOURAL IMPAIRMENTS
Emotional or behavioural disorders resulting from verifiable

neurological impairments (for example, stroke or head injury)
are assessed under Table 12.4 over page.
Psychiatric impairments without documented neurological origin

are assessed under Chapter 5—Psychiatric conditions. They are
not assessed under Table 12.4.
185
Table 12.4: Emotional or behavioural impairments
% WPI Criteria
0 No limitation of activities of daily living and daily social and interpersonal functioning.
Minor limitation of activities of daily living and daily social and interpersonal functioning attributable to the normal
5
variation in the general population.
Mild limitation of activities of daily living and daily social and interpersonal functioning. Impairment levels are
compatible with most usual functioning.
10 Able to live independently, looks after self adequately, with occasional lapses in grooming and observing nutritional
requirements.
Existing relationships strained.
Moderate limitation of some activities of daily living and some daily social and interpersonal functioning.
Cannot live independently without regular support.
30
Needs supervision and/or prompting to perform activities of self-care and personal hygiene.
Previously established relationships severely strained.
Severe limitation in performing most activities of daily living.
50
Impairment significantly impedes useful functioning in most daily social and interpersonal functioning
Severe limitation in performing most activities of daily living.
Impairment significantly impedes useful functioning in most daily social and interpersonal functioning.
65
Needs supervised residential care.
Unable to form or sustain long-term relationships.
Completely unable to perform any daily activities, requiring total dependence on another person.
80 Impairment levels preclude all useful functioning.
Unable to function within society.
Notes to Table 12.4
1. Supervision means the immediate presence of a suitable person, responsible in whole or in part for the care of the employee.
186
12.5 CRANIAL NERVES 12.5.2 The optic nerve, the oculomotor and trochlear nerves
and the abducens (II, III, IV and VI)
Unless otherwise indicated, only the highest WPI rating from the
preceding four categories (that is all tables in sections 12.1, Dysfunction of these cranial nerves causes impairment of the
12.2, 12.3 and 12.4) may be combined with a WPI rating from visual system and is to be assessed under Chapter 6—The
one or more tables in the remainder of Chapter 12, and with visual system.
WPI ratings from other chapters. (For further information about
deriving WPI ratings from an assessment of cerebral function, 12.5.3 The trigeminal nerve (V)
see Steps 1 to 5 in the introduction to Chapter 12).
This is a mixed nerve having sensory fibres to the face, cornea,
anterior scalp, nasal and oral cavities, tongue and supratentorial
12.5.1 The olfactory nerve (I)
dura mater. It also transmits motor impulses to the muscles of
The WPI ratings in Table 12.5.1 reflect bilateral partial loss of mastication.
function and total loss of function (anosmia).
Where sensory loss affects more than one division of the nerve
A WPI rating made under Table 12.5.1 may not be combined with differing severity, the respective values for each affected
with a WPI rating for the same condition made under Table division may be combined using the combined values chart
7.3: Olfaction and Taste (see Chapter 7—Ear, nose and throat (see Appendix 1).
disorders).
If paralysis of the motor fibres of the nerve causes interference
with speech, this impairment should be evaluated in accordance
Table 12.5.1: The olfactory nerve (I)
with the criteria in Chapter 7—Ear, nose and throat disorders.
% WPI Criteria Impairment due to chewing and swallowing difficulties is
2 Bilateral partial loss of function. assessed under Table 12.5.6: The glossopharyngeal, vagus,
spinal accessory and hypoglossal nerves. For the same
5 Bilateral total loss of function.
condition, WPI ratings derived from Table 12.5.6 may not
be combined with WPI ratings from Table 7.7: Chewing and
swallowing (see Chapter 7—Ear, nose and throat disorders).
187
Table 12.5.3: The trigeminal nerve (V)
% WPI Criteria
0 No loss of sensory function.
3 Partial loss of sensory function of any one division of the nerve.
6 Partial loss of sensory function of any two divisions of the nerve.
Complete loss of sensory function of any one division of the nerve
7 and/or
mild uncontrolled facial neuralgic pain that may interfere with activities of daily living.
10 Partial loss of sensory function of all three divisions of the nerve.
Complete loss of sensory function of any two divisions of the nerve
14 and/or
moderately severe, uncontrolled facial neuralgic pain that interferes with activities of daily living.
Complete loss of sensory function of all three divisions of the nerve
20 and/or
severe, uncontrolled, unilateral or bilateral facial neuralgic pain preventing performance of activities of daily living.
188
12.5.4 The facial nerve (VII) Table 12.5.4: The facial nerve (VII)
This is a mixed nerve. The motor part innervates the facial % WPI Criteria
muscles of expression and the accessory muscles for chewing
and swallowing. The sensory fibres carry tactile sensations from Complete loss of taste over anterior two thirds of
tongue
the ear, soft palate and adjacent pharynx, and transmit taste 3
or
from the anterior two thirds of the tongue.
mild unilateral facial weakness.
Impairment due to chewing and swallowing difficulties is
Mild bilateral facial weakness
assessed under Table 12.5.6: The glossopharyngeal, vagus,
or
spinal accessory and hypoglossal nerves. For the same 10 - 12 severe unilateral facial paralysis with 75% or
condition, WPI ratings derived from Table 12.5.6 may not
greater facial involvement and inability to control
be combined with WPI ratings from Table 7.7: Chewing and eyelid closure.
swallowing (see Chapter 7—Ear, nose and throat disorders).
Severe bilateral facial paralysis with 75% or
Facial nerve injury, complicated by visual changes, such as 30 greater facial involvement and inability to control
occur with corneal desiccation and scarring, should rate as a eyelid closure.
significant impairment. This should be assessed under Chapter
6—The visual system, and may be combined with a WPI rating
from Table 12.5.4. 1. Assessors should refer to the Principles of Assessment
for guidance on awarding an impairment value within a
For the same condition, a WPI rating from Table 12.5.4 may not range.
be combined with a WPI rating from Table 7.3: Olfaction and
taste (see Chapter 7—Ear, nose and throat disorders). 12.5.5 The auditory nerve (VIII)
The auditory nerve has two portions:

> the cochlear portion concerned with hearing
> the vestibular portion concerned with balance and spatial
orientation.
Impairment of hearing due to a lesion of the cochlear portion of

the nerve should be evaluated under Chapter 7—Ear, nose and
throat disorders. A WPI rating derived from Chapter 7 may be
combined with a WPI rating from Table 12.5.5.
189
Lesions of the vestibular portion of the nerve result in vertigo with or without nausea and vomiting.
Table 12.5.5 is used where symptoms are continuous.
To obtain the final WPI rating in the case of episodic disturbances of equilibrium (such as Menière’s disease), apply the modifier from
Figure 12-C (see over page) to the WPI rating from Table 12.5.5.
Table 12.5.5: The auditory nerve (VIII)
% WPI Criteria
Symptoms of vestibular dysequilibrium present without supporting objective findings, and activities of daily living can
0
be performed without assistance.
Symptoms of vestibular dysequilibrium present with supporting objective findings, and most activities of daily living
5
can be performed without assistance.
Symptoms of vestibular dysequilibrium present with supporting objective findings, and most activities of daily living,
10 except those of a complex nature (for example, riding a bicycle), or hazardous nature (for example, walking on a roof,
girders or scaffolding), can be performed without assistance.
Symptoms of vestibular dysequilibrium present with supporting objective findings, and assistance is required with
20
most activities of daily living, except self care, walking, and riding in a motor vehicle as a passenger.
Symptoms of vestibular dysequilibrium present with supporting objective findings, and assistance is required with all
30
activities of daily living, except self care.
Symptoms of vestibular dysequilibrium present with supporting objective findings, and assistance is required with all
45
activities of daily living, including self care not requiring ambulation.
Symptoms of vestibular dysequilibrium present with supporting objective findings, and activities of daily living cannot
60
be performed without assistance, including self care.
Symptoms of vestibular dysequilibrium present with supporting objective findings, and activities of daily living cannot
80
be performed without assistance, including self care, and home confinement is necessary

1. Assistance means the immediate presence of a suitable person, responsible in whole or in part for the care of the employee.
190
Figure 12-C: % WPI modifiers for episodic conditions
Signs and symptoms Modifier

Absent. 0.0
Intermittent. 0.2
Present on a daily basis for periods aggregating three or more months per year but less than six months per year. 0.4
Present on a daily basis for periods aggregating six or more months per year but less than eight months per year. 0.6
Present on a daily basis for periods aggregating eight months or more per year but less than ten months per year. 0.8
Present on a daily basis for period aggregating ten months per year or more. 1.0
12.5.6 The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII)
The spinal accessory nerve assists the vagus nerve in supplying some of the muscles of the larynx, and innervates the cervical
portions of the sternocleidomastoid and trapezius muscles.
Disorders of these nerves affecting musculoskeletal function should be assessed in accordance with criteria contained in Chapter 9—
Musculoskeletal system.
The glossopharyngeal nerve and the vagus nerve are mixed nerves supplying sensory fibres to the posterior third of the tongue, larynx
and trachea. Sensory impairment may contribute to difficulties swallowing, breathing and speaking.
The hypoglossal nerve is a motor nerve that innervates the musculature of the tongue.
Dysarthia is a situation where the articulation of the voice mechanism is at fault. Pronunciation is unclear, although the linguistic
content and meaning are normal.
Dysphagia is a condition in which the action of swallowing is difficult to perform, painful, or in which swallowed material is delayed
in its passage to the stomach. Speech is slowed or slurred and may be completely unintelligible or non-functional. All other causes of
difficulty with chewing or swallowing should be assessed using Table 7.7: Chewing and swallowing (see Chapter 7—Ear, nose and
throat disorders). For the same condition, WPI ratings from Table 7.7 may not be combined with WPI ratings from Table 12.5.6.
191
Table 12.5.6: The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves (IX, X, XI and XII)

Mild dysarthria (speech slow or slurred especially when tired).
Dystonia (only neurological).
10 Mild dysphagia (coughing on liquids or semi-solid foods).
Diet limited to semi-solid or soft foods.
Spasmodic torticollis (only neurological).
Moderately severe dysarthia (speech is laboured, imprecise, and often unintelligible).
Speaker is required to repeat often and may need augmentative device to help convey message.
25
Moderately severe dysphagia with nasal regurgitation and aspiration of liquids and semisolid foods.
Diet limited to liquid foods.
Severe dysarthia – speech may be completely unintelligible or non-functional, or intelligible only to familiar people,
and only with the aid of an augmentative communication device.
50 Severe dysphagia (inability to swallow food, liquids or manage oral secretions).
Regular suctioning required.
Ingestion of food requires tube feeding or gastrotomy.
192
12.6 NEUROLOGICAL IMPAIRMENT OF THE RESPIRATORY 12.7 NEUROLOGICAL IMPAIRMENT OF THE URINARY SYSTEM
SYSTEM
Where there is loss of bladder control due to a neurological
Where the ability to breathe is impaired because of a impairment, Table 12.7 may be used.
neurological impairment, Table 12.6 below may be used.
Impairments of the urinary system not of documented
Impairments of the respiratory system not of documented
neurological origin are assessed under Chapter 10—Urinary
neurological origin are assessed under Chapter 2—The
system. They are not assessed under Table12.7.
respiratory system. They are not assessed under Table 12.6.
Documentation by cystometric and other relevant urologic tests
Table 12.6: Neurological impairment of the respiratory system may be necessary.
% WPI Criteria The status of the upper urinary tract must also be considered.
Except for an impairment of bladder function, if several
Able to breathe spontaneously but has difficulty
10 performing activities of daily living that require impairments of the urinary system are present, a WPI rating from
moderate exertion. Table 12.7 may be combined with a WPI rating from Chapter
10—Urinary system.
Able to breathe spontaneously but is restricted to
25
sitting, standing or limited walking.
Table 12.7: Neurological impairment of the urinary system
Able to breathe spontaneously but to such a
60 limited degree that the employee is confined to % WPI Criteria
bed.
Some degree of voluntary control but impaired by
90 No capacity for spontaneous respiration. 5
urgency or intermittent incontinence.
Good bladder reflex activity, limited capacity, and
10 - 15
intermittent emptying without voluntary control.
Poor bladder reflex activity, intermittent dribbling,
30
and no voluntary control.
50 No reflex or voluntary control of the bladder.
Notes to Table 12.7

1. Assessors should refer to the Principles of Assessment
for guidance on awarding an impairment value within a
range.
193
12.8 NEUROLOGICAL IMPAIRMENT OF THE ANORECTAL 12.9 NEUROLOGICAL IMPAIRMENT AFFECTING SEXUAL
SYSTEM FUNCTION
Where there is loss of ability to control emptying because of Where there is loss of awareness and the capability of having
a neurological impairment, Table 12.8 below may be used. an orgasm because of a neurological impairment, Table 12.9
Impairments of the anorectal system not of documented below may be used. Impairments of sexual function not of
neurological origin are assessed under Chapter 8—The digestive documented neurological origin are not assessed under Table
system. They are not assessed under Table 12.8. 12.9. They are assessed under Chapter 11—The reproductive
system.
Table 12.8: Neurological impairment of the anorectal system
The employee’s previous sexual functioning should be
% WPI Criteria considered.
Reflex regulation but only limited voluntary Impairment of the peripheral nervous system is assessed using
10
control. the methodology for assessing the lower and upper extremities
20 Reflex regulation but no voluntary control. described in Chapter 9—The musculoskeletal system.
40 No reflex regulation or voluntary control. Table 12.9: Neurological impairment affecting sexual function
% WPI Criteria
Sexual functioning is possible, but with difficulty
of erection or ejaculation in men, or lack of
10
awareness, excitement or lubrication in either
sex.
Reflex sexual functioning is possible, but there is
15
no awareness.
20 No sexual functioning.
194
CHAPTER 13—THE HAEMATOPOIETIC SYSTEM

13.1 ANAEMIA 195
13.2 LEUKOCYTE ABNORMALITIES OR DISEASE 195
13.3 HAEMORRHAGIC DISORDERS AND PLATELET DISORDERS 198
13.4 THROMBOTIC DISORDERS 198
195
13.0 INTRODUCTION 13.2 LEUKOCYTE ABNORMALITIES OR DISEASE
In conducting an assessment, the assessor must have regard Chronic low white cell counts (for example, neutropenia) are
to the principles of assessment (see pages 9-13) and the usually associated with substantially increased risk of infection.
definitions contained in the glossary (see page 14). Impairment is measured in terms of the infection.
Neoplastic disorders of leukocytes include leukaemias,

13.1 ANAEMIA
lymphomas, multiple myeloma, and macroglobulinaemia. Some
Iron deficiency anaemia and megaloblastic anaemia are of these disorders (chronic lymphatic leukaemia, hairy cell
generally manageable with proper treatment and should not leukaemia, and some lymphomas) may cause no impairment
cause permanent impairment. Some haemolytic anaemias for many years.
are reversible with appropriate therapy, such as steroids or
Similarly, multiple myeloma and macroglobulinaemia may
splenectomy, and also should result in negligible impairment.
be initially asymptomatic, and cause no gastrointestinal
The impairment resulting from persistent refractory anaemia, haemorrhage, bone pain, or need for chemotherapy or radiation.
whether haemolytic or aplastic, is assessed using Table 13.1.
The impairment should be assessed by reference to the
appropriate chapters of this guide.
Table 13.1: Anaemia
As the early stages of HIV infection are not likely to manifest in
impaired organ systems, Table 13.2 alone should be used to
assess any impairment. Where organ systems are impaired
Haemoglobin
% WPI Transfusion requirements as the disease progresses, impairment should be assessed
level
using those chapters of the guide which assess impairment of
0 100-120g/L None the principal organ systems affected by the disease: including,
10 80-100g/L None but not limited to, Chapter 2—The respiratory system, Chapter
8—The digestive system, Chapter 10—The urinary system, and
20 80-100g/L 2 Units every 6 weeks
Chapter 12—The neurological system. If several systems are
40 <80g/L 2-3 Units every 4 to 6 weeks involved, the WPI ratings derived for each system are combined
60 <80g/L 2-3 Units every 2-3 weeks using the combined values chart (see Appendix 1).
The combined impairment should then be compared with the

Note to Table 13.1. WPI rating from Table 13.2 in order to ascertain the more
beneficial WPI rating.
1. The haemoglobin levels referred to in Table 13.1 are the
levels prior to transfusion.
196
The contribution of side effects of drug treatment to overall Figure 13-A: Activities of daily living
impairment should also be considered.
Activity Examples
The same principle applies to other conditions of the
haematopoietic system where organ systems are impaired by Self care, personal Bathing, grooming, dressing, eating,
hygiene eliminating.
the disease process and impairment can be assessed using
other chapters of the guide. Hearing, speaking, reading, writing,
Communication
using keyboard.
‘Activities of daily living’ are activities which an employee needs
Standing, sitting, reclining, walking,
to perform to function in a non-specific environment (that is, to
stooping, squatting, kneeling, reaching,
live). Performance of activities of daily living is measured by Physical activity bending, twisting, leaning, carrying,
reference to primary biological and psychosocial function. lifting, pulling, pushing, climbing,
exercising.
For the purposes of Table 13.2: Leukocyte abnormalities or
disease (see following page), activities of daily living are those Sensory function Tactile feeling.
in Figure 13-A. Grasping, holding, pinching, percussive
Hand functions
movements, sensory discrimination.
197
Table 13.2: Leukocyte abnormalities or disease

Signs of leukocyte abnormality but no symptoms.
0 No or infrequent treatment needed.
All the activities of daily living can be performed.
Signs and symptoms of leukocyte abnormality.
10 Infrequent treatment needed.
Almost all the activities of daily living can be performed.
20 Continuous or regular treatment needed.
Most of the activities of daily living can be performed.
Continuous or regular treatment needed.
30
Interference with the performance of the activities of daily living to the extent that some assistance from others is
required.
50
Interference with the performance of the activities of daily living to the extent that considerable assistance from others is
required.
70
Interference with the performance of the activities of daily living to the extent that continuous assistance from others is
required.
80 Continuous or regular treatment needed.
Totally dependent on others for performance of all activities of daily living.
198
Notes to Table 13.2 Table 13.3: Haemorrhagic disorders and platelet disorders
1. Assistance means the immediate presence of a suitable % WPI Criteria

person, responsible in whole or in part for the care of the
employee. Splenectomy
0 or
2. Suitable person means a person capable of responsibly easy bruising.
caring for the employee in an appropriate way.
10 Continuous or regular medication is required.
13.3 HAEMORRHAGIC DISORDERS AND PLATELET DISORDERS 25 Refractory thrombocytopenia <20,000/μL.
Thrombocytopenia does not constitute an impairment unless

13.4 THROMBOTIC DISORDERS
severe and not reversible by steroids, splenectomy, or other
therapy. Long-term prophylaxis means prophylaxis continuing for at least
two years.
A bleeding disorder that causes problems only after trauma or
surgery does not constitute a permanent bleeding impairment. Employees who have permanent respiratory or cardiac
limitations secondary to massive pulmonary embolism
Where an injury is made more severe by the presence of an
should be assessed as appropriate under Chapter 1—The
underlying bleeding disorder, a combined WPI rating is allowed,
cardiovascular system, and Chapter 2—The respiratory system.
incorporating values for bleeding sites or organ damage. A WPI
rating obtained from tables in other chapters may be combined For specific levels of impairment for post-thrombotic syndrome,
with a WPI rating obtained from Table 13.3. use Table 1.4: Peripheral vascular disease of the lower
extremities, or Table 1.6: Raynaud’s disease, Chapter 1—The
Other complications of bleeding disorders, including
cardiovascular system). These tables may be used as an
gastrointestinal, mucosal or intramuscular haemorrhage, should
alternative. WPI ratings from Tables 1.4 or 1.6, and Table 13.4,
also be assessed according to the site of the blood loss under
must not be combined.
other Chapters of the guide, including Chapter 8—The digestive
system, and/or Table 13.1: Anaemia. Tables 1.5 and 1.6 should be used as the primary guide for
assessing peripheral complications of thrombosis.
A WPI rating obtained from other tables in this guide should be
combined with a WPI rating obtained from Table 13.3.
199
Table 13.4: Thrombotic disorders
% WPI Criteria
0 Superficial thrombosis or thrombophlebitis.
Deep venous or other thrombosis requiring long-
10
term prophylaxis with warfarin.
30 Post-phlebitic syndrome.
200
PART 1
DIVISION 2—GUIDE TO THE ASSESSMENT OF NON-ECONOMIC LOSS
INTRODUCTION Listed below are the tables in Division 2 used to calculate a

reasonable percentage.
The degree of non-economic loss is to be assessed in
accordance with Division 2. Pain:
Table B1—Pain
The compensation payable for non-economic loss is divided into
two equal amounts. Suffering:
The worksheet—calculation of non-economic loss (see section Table B2—Suffering
B6) uses the following formula to calculate the total payable in
Loss of amenities:
an individual case:
Table B3.1—Mobility
A + B = $Total Table B3.2—Social relationships
WHERE A = the percentage assessment of total Table B3.3—Recreation and leisure activities
permanent impairment, multiplied by
Other loss:
the first half of the maximum
Table B4—Other loss
AND B = a reasonable percentage of the second
Loss of expectation of life:
half of the maximum having
regard to the non-economic loss Table B5—Loss of expectation of life.
suffered
Scores derived from these tables are then transferred to the
worksheet—calculation of non-economic loss (see section B6).
201
B1. PAIN Table B1: Pain
Using Table B1, a score out of five is assessed for pain. Score Description of level of effect
Using the worksheet—calculation of non-economic loss (see No pain experienced.
0
section B6), the score for pain is combined with the scores VAPS = 0
derived from Tables B2, B3.1, B3.2, B3.3, B4 and B5.
Intermittent attacks of pain of nuisance value only.
Pain means physical pain. 1 Can be ignored when activity commences.
VAPS = 1-2
Only ongoing pain of a continuing or episodic nature is
considered. Intermittent attacks of pain.
Not easily tolerated, but short-lived.
This table does not include temporary pain. Nor does it include Pain responds fairly readily to treatment
2
speculation of future pain that has not yet manifested itself. (for example, analgesics, anti-inflammatory
medications).
In Table B1, VAPS means ‘visual analogue pain scale’, with 0
VAPS = 3-4
being no pain, and 10 being the worst pain ever experienced.
Episodes of pain more persistent.
Not easily tolerated.
3
Treatment, if available, of limited benefit.
VAPS = 5-6
Pain occurring most of the time.
Restrictions on activity.
4
Resistant to treatment.
VAPS = 7-8
Pain continuous and severe.
Preventing activity.
5
Uncontrolled by medication.
VAPS = 9-10
202
B2. SUFFERING Table B2: Suffering
Using Table B2, a score out of five is assessed for suffering. Score Description of level of effect
Using the worksheet—calculation of non-economic loss (see 0 No symptoms of mental distress experienced.
section B6), the score for Suffering is combined with the scores Symptoms of mental distress minimal or ill
derived from Tables B1, B3.1, B3.2, B3.3, B4 and B5. defined.
1
Symptoms occur intermittently.
Suffering means the mental distress resulting from the accepted
No interference with activity.
conditions or impairment.
Distinct symptoms of mental distress which are
It includes emotional symptoms which are within the normal episodic in nature.
2
range of human responses to distressing events such as grief, Activities reduced during such episodes.
anguish, fear, frustration, humiliation, embarrassment. Recovers quickly after episodes.
Only ongoing suffering of a continuing or episodic nature is Symptoms of mental distress are distinct and
varied.
considered.
Episodes of mental distress occur regularly.
Table B2 does not include: Ability to cope or perform activity effectively
reduced during episodes.
> temporary suffering 3
Needs time to recover between episodes.
> speculation about future suffering that has not yet Treatment—medication such as anti-depressants,
manifested itself. counselling or other therapy by a psychologist
or psychiatrist, or other supportive therapy—is of
benefit in controlling or relieving symptoms.
Symptoms of mental distress are wide ranging and
tend to dominate thinking.
Rarely free of symptoms of mental distress.
4
Difficulty coping or performing activity.
Treatment necessary either to control or relieve
symptoms.
Symptoms of mental distress arising from accepted
condition interferes with normal thought processes.
5 Activities severely restricted.
Treatment of no real benefit in controlling or
relieving symptoms.
203
B3. LOSS OF AMENITIES Table B3.1: Mobility
‘Loss of amenities’ is also known as ‘loss of enjoyment of life’. Score Description of level of effect
Loss of amenities and leisure activities means the effects on 0 No or minimal restrictions on mobility.
mobility, social relationships and recreation.
Periodic effects on mobility, resulting in the need
A score out of five is assessed for each of the following: for some assistance
1 or
> Mobility (using Table B3.1—Mobility). ‘Mobility’ refers to
effects continuing but mild (such as slowing of
the employee’s ongoing ability to move around in his or pace or the need for a walking stick).
her environment. This includes walking, driving, being a
Mobility reduced, but remains independent of
passenger, using public transport
others both within and outside the home.
2
> Social relationships (using Table B3.2—Social Can travel but may require rest breaks, special
relationships, see following page). ‘Social relationships’ seating, or other special treatment.
refers to the employee’s ongoing capacity to engage in Mobility markedly reduced.
usual social and personal relationships
3 Needs some assistance from others.
> Recreation and leisure activities (using Table B3.3— Unable to use most forms of transport.
Recreation and leisure activities, see following page).
Restricted to home and vicinity.
‘Recreation and leisure activities’ refers to the employee’s
4 Can only travel outside home with door to door
ongoing ability to maintain customary recreational and transport and the assistance of others.
leisure pursuits.
Severely restricted mobility (for example, bed,
Using the worksheet—calculation of non-economic loss (see chair, room).
section B6), these scores are then combined with the scores 5 Dependent on others for assistance.
derived from Tables B1, B1, B4 and B5. Mechanical devices or appliances used for mobility
within the home (for example, wheelchair, hoist).
204
Table B3.2: Social relationships Table B3.3: Recreation and leisure activities
Score Description of level of effect Score Description of level of effect

0 Usual relationships unaffected. 0 Able to follow usual recreation and leisure activities
Minor interference with personal relationships, Intermittent interference with activities.
1 causing some reduction in social activities and 1 In between episodes able to pursue usual
contacts. activities.
Relationships confined to immediate and extended Interference to activities reduces frequency of
2 family and close friends, but unable to relate to 2 activity, but is able to continue.
casual acquaintances.
Is able to follow alternatives.
Difficulty in maintaining relationships with close
3 Unable to continue with pre-injury level of activity.
friends and the extended family. 3
Alternative activity possible.
4 Social contacts confined to immediate family.
Range of pre-injury activities greatly reduced.
5 Difficulties relating socially to anyone. 4 Needs some assistance to participate in pre-injury
recreation and leisure activities.
Unable to undertake any pre-injury recreation and
5
leisure activities.
205
B4. OTHER LOSS B5. LOSS OF EXPECTATION OF LIFE
Table B4 is used to assess losses of a non-economic nature that A score out of three is assessed.
are not adequately covered by Tables B1, B2, B3.1, B3.2, B3.3,
Using the worksheet—calculation of non-economic loss (see
or B5.
section B6), this score is then combined with the scores derived
A score out of three is assessed. from Tables B1, B1, B3.1, B3.2, B3.3, and B4.
Using the worksheet—calculation of non-economic loss (see Loss of expectation of life is restricted to a maximum of three
section B6), this score is then combined with the scores derived points because of the value placed on it by the courts in
from Tables B1, B2, B3.1, B3.2, B3.4, and B5. damages cases.
Table B4: Other loss Table B5: Loss of expectation of life
Score Description of level of effect Score Description of level of effect

0 Nil or minimal disadvantages. 0 Loss of life expectancy of less than one year.
Moderate disadvantages. For example, Loss of life expectancy of one year to less than 10
1
dependence upon a specialised diet; detrimental years.
1
effects of climatic features including temperature,
humidity, ultra-violet rays, light, noise, dust. Loss of life expectancy of 10 years to less than 20
2
years.
Marked disadvantages. For example, requirement
2 3 Loss of life expectancy of 20 years or greater.
to move to specially modified premises.
Severe disadvantages. For example, dependence
upon external life saving or supporting machines
3 including aspirator, respirator, dialysis machine,
or any form of electro-mechanical device for the
sustenance or extension of activities.
206
B6. CALCULATION OF NON-ECONOMIC LOSS
This worksheet allows for the calculation of the percentage of non-economic loss suffered by the employee for the purposes of section
27 of the SRC Act.
Table B6: Worksheet—calculation of non-economic loss
STEP 1—Calculation of total score from Division 2 tables
Table Score Factor Final score

B1: Pain x 0.5 =
B2: Suffering x 0.5 =
B3: Amenities of life
B3.1: Mobility score x 0.6 =
B3.2: Social relationships x 0.6 =
B3.3: Recreation and leisure activities x 0.6 =
B4: Other loss x 1.0 =
B5: Loss of expectation of life x 1.0 =
Total of scores =
207
STEP 2—Conversion of total of scores to a percentage
Choose either Step 2.1 or Step 2.2

Step 2.1
If the total of scores from Step 1 above:
> equals 15; or
> is greater than 15
then the percentage non-economic loss suffered by the employee is 100%.
or
Step 2.2
If the total of scores from Step 1 above is less than 15, insert in the grey shaded area below the total of scores from Step 1 above.
Complete the calculation to find the percentage non-economic loss suffered by the employee:
____________ x 100 = _______%

15
208
PART 1
DIVISION 3—CALCULATION OF TOTAL ENTITLEMENT UNDER SECTION
24 AND SECTION 27
Use the following worksheet to derive the total entitlement.
C1: Worksheet—calculation of total entitlement
Benefit levels are available from Comcare. They are indexed annually on 1 July in accordance with movements in the Consumer Price
Index.
Calculate total whole person impairment entitlement

Calculate ss24(9) indexed amount for permanent impairment:
Step one
WPI% x $ $
Calculate part A of ss27(2) indexed amount for non-economic loss:
Step twp
WPI% x $ $
Calculate part B of ss27(2) indexed amount for non-economic loss:
Step three
_____ % Non-economic loss (from B6) x $ $
Step four permanent impairment entitlement: $
209
PART 1
APPENDIX 1—COMBINED VALUES CHART
COMBINED VALUES CHART
The values are derived from the formula:
A + B(1-A) = combined value of A and B
where A and B are the decimal equivalents of the WPI ratings
In the chart all values are expressed as percentages. To combine

any two impairment values, locate the larger of the values on the
side of the chart and read along that row until you come to the
column indicated by the smaller value at the bottom of the chart.
At the intersection of the row and the column is the combined
value.
For example, to combine 35% and 20%, read down the side
of the chart until you come to the larger value, 35%. Then read
across the 35% row until you come to the column indicated by
20% at the bottom of the chart. At the intersection of the row and
column is the number 48. Therefore, 35% combined with 20%
is 48%. Because of the construction of this chart, the larger
impairment value must be identified at the side of the chart.
If three or more impairment values are to be combined, sort the

impairment values from highest to lowest, select the highest and
find their combined values as above. The use that combined
value and the third highest impairment value to locate the
combined value of all.
This process can be repeated indefinitely, the final value in each

instance being the combination of all the previous values. In
each step of this process the larger impairment value must be
identified at the side of the chart.
Part 1 Appendix 1: Combined values chart
Source: American Medical Association’s Guides to the Evaluation of Permanent Impairment, 5th edition, page 604.
1 2
2 3 4
3 4 5 6
4 5 6 7 8
5 6 7 8 9 10
6 7 8 9 10 11 12
7 8 9 10 11 12 13 14
8 9 10 11 12 13 14 14 15
9 10 11 12 13 14 14 15 16 17
10 11 12 13 14 15 15 16 17 18 19
11 12 13 14 15 15 16 17 18 19 20 21
12 13 14 15 16 16 17 18 19 20 21 22 23
13 14 15 16 16 17 18 19 20 21 22 23 23 24
14 15 16 17 17 18 19 20 21 22 23 23 24 25 26
15 16 17 18 18 19 20 21 22 23 24 24 25 26 27 28
16 17 18 19 19 20 21 22 23 24 24 25 26 27 28 29 29
17 18 19 19 20 21 22 23 24 24 25 26 27 28 29 29 30 31
18 19 20 20 21 22 23 24 25 25 26 27 28 29 29 30 31 32 33
19 20 21 21 22 23 24 25 25 26 27 28 29 30 30 31 32 33 34 34
20 21 22 22 23 24 25 26 26 27 28 29 30 30 31 32 33 34 34 35 36
21 22 23 23 24 25 26 27 27 28 29 30 30 31 32 33 34 34 35 36 37 38
22 23 24 24 25 26 27 27 28 29 30 31 31 32 33 34 34 35 36 37 38 38 39
23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 35 35 36 37 38 38 39 40 41
24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42
25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44
26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45
27 28 28 29 30 31 31 32 33 34 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47
28 29 29 30 31 32 32 33 34 34 35 36 37 37 38 39 40 40 41 42 42 43 44 45 45 46 47 47 48
29 30 30 31 32 33 33 34 35 35 36 37 38 38 39 40 40 41 42 42 43 44 45 45 46 47 47 48 49 50
30 31 31 32 33 34 34 35 36 36 37 38 38 39 40 41 41 42 43 43 44 45 45 46 47 48 48 49 50 50 51
31 32 32 33 34 34 35 36 37 37 38 39 39 40 41 41 42 43 43 44 45 45 46 47 48 48 49 50 50 51 52 52
32 33 33 34 35 35 36 37 37 38 39 39 40 41 42 42 43 44 44 45 46 46 47 48 48 49 50 50 51 52 52 53 54
33 34 34 35 36 36 37 38 38 39 40 40 41 42 42 43 44 44 45 46 46 47 48 48 49 50 50 51 52 52 53 54 54 55
34 35 35 36 37 37 38 39 39 40 41 41 42 43 43 44 45 45 46 47 47 48 49 49 50 51 51 52 52 53 54 54 55 56 56
35 36 36 37 38 38 39 40 40 41 42 42 43 43 44 45 45 46 47 47 48 49 49 50 51 51 52 53 53 54 55 55 56 56 57 58
36 37 37 38 39 39 40 40 41 42 42 43 44 44 45 46 46 47 48 48 49 49 50 51 51 52 53 53 54 55 55 56 56 57 58 58 59
37 38 38 39 40 40 41 41 42 43 43 44 45 45 46 46 47 48 48 49 50 50 51 51 52 53 53 54 55 55 56 57 57 58 58 59 60 60
38 39 39 40 40 41 42 42 43 44 44 45 45 46 47 47 48 49 49 50 50 51 52 52 53 54 54 55 55 56 57 57 58 58 59 60 60 61 62
39 40 40 41 41 42 43 43 44 44 45 46 46 47 48 48 49 49 50 51 51 52 52 53 54 54 55 55 56 57 57 58 59 59 60 60 61 62 62 63
40 41 41 42 42 43 44 44 45 45 46 47 47 48 48 49 50 50 51 51 52 53 53 54 54 55 56 56 57 57 58 59 59 60 60 61 62 62 63 63 64
41 42 42 43 43 44 45 45 46 46 47 47 48 49 49 50 50 51 52 52 53 53 54 55 55 56 56 57 58 58 59 59 60 60 61 62 62 63 63 64 65 65
42 43 43 44 44 45 45 46 47 47 48 48 49 50 50 51 51 52 52 53 54 54 55 55 56 57 57 58 58 59 59 60 61 61 62 62 63 63 64 65 65 66 66
43 44 44 45 45 46 46 47 48 48 49 49 50 50 51 52 52 53 53 54 54 55 56 56 57 57 58 58 59 60 60 61 61 62 62 63 64 64 65 65 66 66 67 68
44 45 45 46 46 47 47 48 48 49 50 50 51 51 52 52 53 54 54 55 55 56 56 57 57 58 59 59 60 60 61 61 62 62 63 64 64 65 65 66 66 67 68 68 69
45 46 46 47 47 48 48 49 49 50 51 51 52 52 53 53 54 54 55 55 56 57 57 58 58 59 59 60 60 61 62 62 63 63 64 64 65 65 66 66 67 68 68 69 69 70
46 47 47 48 48 49 49 50 50 51 51 52 52 53 54 54 55 55 56 56 57 57 58 58 59 60 60 61 61 62 62 63 63 64 64 65 65 66 67 67 68 68 69 69 70 70 71
47 48 48 49 49 50 50 51 51 52 52 53 53 54 54 55 55 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 65 66 66 67 67 68 68 69 69 70 70 71 71 72
48 49 49 50 50 51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73
49 50 50 51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 74
50 51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 74 74 75 75
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
Part 1—Combined values chart (continued)
51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 74 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 74 74 75 75 76
52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 74 74 75 75 76 76
53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 69 70 70 71 71 72 72 73 73 74 74 75 75 76 76 77
54 54 55 55 56 56 57 57 58 58 59 59 60 60 60 61 61 62 62 63 63 64 64 65 65 66 66 66 67 67 68 68 69 69 70 70 71 71 71 72 72 73 73 74 74 75 75 76 76 77 77
55 55 56 56 57 57 58 58 59 59 60 60 60 61 61 62 62 63 63 64 64 64 65 65 66 66 67 67 68 68 69 69 69 70 70 71 71 72 72 73 73 73 74 74 75 75 76 76 77 77 78
56 56 57 57 58 58 59 59 60 60 60 61 61 62 62 63 63 63 64 64 65 65 66 66 67 67 67 68 68 69 69 70 70 71 71 71 72 72 73 73 74 74 74 75 75 76 76 77 77 78 78
57 57 58 58 59 59 60 60 60 61 61 62 62 63 63 63 64 64 65 65 66 66 66 67 67 68 68 69 69 69 70 70 71 71 72 72 72 73 73 74 74 75 75 75 76 76 77 77 78 78 79
58 58 59 59 60 60 61 61 61 62 62 63 63 63 64 64 65 65 66 66 66 67 67 68 68 69 69 69 70 70 71 71 71 72 72 73 73 74 74 74 75 75 76 76 76 77 77 78 78 79 79
59 59 60 60 61 61 61 62 62 63 63 64 64 64 65 65 66 66 66 67 67 68 68 68 69 69 70 70 70 71 71 72 72 73 73 73 74 74 75 75 75 76 76 77 77 77 78 78 79 79 80
60 60 61 61 62 62 62 63 63 64 64 64 65 65 66 66 66 67 67 68 68 68 69 69 70 70 70 71 71 72 72 72 73 73 74 74 74 75 75 76 76 76 77 77 78 78 78 79 79 80 80
61 61 62 62 63 63 63 64 64 65 65 65 66 66 66 67 67 68 68 68 69 69 70 70 70 71 71 72 72 72 73 73 73 74 74 75 75 75 76 76 77 77 77 78 78 79 79 79 80 80 81
62 62 63 63 64 64 64 65 65 65 66 66 67 67 67 68 68 68 69 69 70 70 70 71 71 72 72 72 73 73 73 74 74 75 75 75 76 76 76 77 77 78 78 78 79 79 79 80 80 81 81
63 63 64 64 64 65 65 66 66 66 67 67 67 68 68 69 69 69 70 70 70 71 71 72 72 72 73 73 73 74 74 74 75 75 76 76 76 77 77 77 78 78 79 79 79 80 80 80 81 81 82
64 64 65 65 65 66 66 67 67 67 68 68 68 69 69 69 70 70 70 71 71 72 72 72 73 73 73 74 74 74 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 81 81 81 82 82
65 65 66 66 66 67 67 67 68 68 69 69 69 70 70 70 71 71 71 72 72 72 73 73 73 74 74 74 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 81 81 81 82 82 83
66 66 67 67 67 68 68 68 69 69 69 70 70 70 71 71 71 72 72 72 73 73 73 74 74 75 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 81 81 81 82 82 82 83 83
67 67 68 68 68 69 69 69 70 70 70 71 71 71 72 72 72 73 73 73 74 74 74 75 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 81 81 81 82 82 82 83 83 83 84
68 68 69 69 69 70 70 70 71 71 71 72 72 72 72 73 73 73 74 74 74 75 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 80 81 81 81 82 82 82 83 83 83 84 84
69 69 70 70 70 71 71 71 71 72 72 72 73 73 73 74 74 74 75 75 75 76 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 80 81 81 81 82 82 82 83 83 83 84 84 84 85
70 70 71 71 71 72 72 72 72 73 73 73 74 74 74 75 75 75 75 76 76 76 77 77 77 78 78 78 78 79 79 79 80 80 80 81 81 81 81 82 82 82 83 83 83 84 84 84 84 85 85
71 71 72 72 72 72 73 73 73 74 74 74 74 75 75 75 76 76 76 77 77 77 77 78 78 78 79 79 79 79 80 80 80 81 81 81 81 82 82 82 83 83 83 83 84 84 84 85 85 85 86
72 72 73 73 73 73 74 74 74 75 75 75 75 76 76 76 76 77 77 77 78 78 78 78 79 79 79 80 80 80 80 81 81 81 82 82 82 82 83 83 83 83 84 84 84 85 85 85 85 86 86
73 73 74 74 74 74 75 75 75 75 76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 81 81 81 81 82 82 82 82 83 83 83 84 84 84 84 85 85 85 85 86 86 86 87
74 74 75 75 75 75 76 76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 81 81 81 81 82 82 82 82 83 83 83 83 84 84 84 84 85 85 85 85 86 86 86 86 87 87
75 75 76 76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 80 81 81 81 81 82 82 82 82 83 83 83 83 84 84 84 84 85 85 85 85 86 86 86 86 87 87 87 87 88
76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 80 81 81 81 81 82 82 82 82 82 83 83 83 83 84 84 84 84 85 85 85 85 86 86 86 86 87 87 87 87 88 88 88
77 77 77 78 78 78 78 79 79 79 79 80 80 80 80 80 81 81 81 81 82 82 82 82 83 83 83 83 83 84 84 84 84 85 85 85 85 86 86 86 86 86 87 87 87 87 88 88 88 88 89
78 78 78 79 79 79 79 80 80 80 80 80 81 81 81 81 82 82 82 82 82 83 83 83 83 84 84 84 84 84 85 85 85 85 85 86 86 86 86 87 87 87 87 87 88 88 88 88 89 89 89
79 79 79 80 80 80 80 80 81 81 81 81 82 82 82 82 82 83 83 83 83 83 84 84 84 84 84 85 85 85 85 86 86 86 86 86 87 87 87 87 87 88 88 88 88 88 89 89 89 89 90
80 80 80 81 81 81 81 81 82 82 82 82 82 83 83 83 83 83 84 84 84 84 84 85 85 85 85 85 86 86 86 86 86 87 87 87 87 87 88 88 88 88 88 89 89 89 89 89 90 90 90
81 81 81 82 82 82 82 82 83 83 83 83 83 83 84 84 84 84 84 85 85 85 85 85 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 89 89 89 89 89 90 90 90 90 90 91
82 82 82 83 83 83 83 83 83 84 84 84 84 84 85 85 85 85 85 85 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 88 89 89 89 89 89 90 90 90 90 90 90 91 91 91
83 83 83 84 84 84 84 84 84 85 85 85 85 85 85 86 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 88 89 89 89 89 89 89 90 90 90 90 90 90 91 91 91 91 91 92
84 84 84 84 85 85 85 85 85 85 86 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 88 88 89 89 89 89 89 89 90 90 90 90 90 90 91 91 91 91 91 91 92 92 92 92
85 85 85 85 86 86 86 86 86 86 87 87 87 87 87 87 87 88 88 88 88 88 88 88 89 89 89 89 89 89 90 90 90 90 90 90 90 91 91 91 91 91 91 91 92 92 92 92 92 92 93
86 86 86 86 87 87 87 87 87 87 87 88 88 88 88 88 88 88 89 89 89 89 89 89 89 90 90 90 90 90 90 90 90 91 91 91 91 91 91 91 92 92 92 92 92 92 92 93 93 93 93
87 87 87 87 88 88 88 88 88 88 88 88 89 89 89 89 89 89 89 89 90 90 90 90 90 90 90 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 94
88 88 88 88 88 89 89 89 89 89 89 89 89 90 90 90 90 90 90 90 90 91 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 94 94 94 94 94
89 89 89 89 89 90 90 90 90 90 90 90 90 90 91 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 95
90 90 90 90 90 91 91 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95
91 91 91 91 91 91 92 92 92 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 96
92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96
93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 96 96 96 96 96 97
94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97
95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98
96 96 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98
97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99
98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99
99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
51 76
52 76 77
53 77 77 78
54 77 78 78 79
55 78 78 79 79 80
56 78 79 79 80 80 81
57 79 79 80 80 81 81 82
58 79 80 80 81 81 82 82 82
59 80 80 81 81 82 82 82 83 83
60 80 81 81 82 82 82 83 83 84 84
61 81 81 82 82 82 83 83 84 84 84 85
62 81 82 82 83 83 83 84 84 84 85 85 86
63 82 82 83 83 83 84 84 84 85 85 86 86 86
64 82 83 83 83 84 84 85 85 85 86 86 86 87 87
65 83 83 84 84 84 85 85 85 86 86 86 87 87 87 88
66 83 84 84 84 85 85 85 86 86 86 87 87 87 88 88 88
67 84 84 84 85 85 85 86 86 86 87 87 87 88 88 88 89 89
68 84 85 85 85 86 86 86 87 87 87 88 88 88 88 89 89 89 90
69 85 85 85 86 86 86 87 87 87 88 88 88 89 89 89 89 90 90 90
70 85 86 86 86 87 87 87 87 88 88 88 89 89 89 90 90 90 90 91 91
71 86 86 86 87 87 87 88 88 88 88 89 89 89 90 90 90 90 91 91 91 92
72 86 87 87 87 87 88 88 88 89 89 89 89 90 90 90 90 91 91 91 92 92 92
73 87 87 87 88 88 88 88 89 89 89 89 90 90 90 91 91 91 91 92 92 92 92 93
74 87 88 88 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93
75 88 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93 93 94 94
76 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93 93 94 94 94 94
77 89 89 89 89 90 90 90 90 91 91 91 91 91 92 92 92 92 93 93 93 93 94 94 94 94 94 95
78 89 89 90 90 90 90 91 91 91 91 91 92 92 92 92 93 93 93 93 93 94 94 94 94 95 95 95 95
79 90 90 90 90 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 95 95 95 95 95 96
80 90 90 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 95 95 95 95 95 96 96 96
81 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 96 96 96 96 96
82 91 91 92 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 96 96 96 96 96 96 97 97
83 92 92 92 92 92 93 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 97 97 97 97
84 92 92 92 93 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97
85 93 93 93 93 93 93 94 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97 97 98 98
86 93 93 93 94 94 94 94 94 94 94 95 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 98 98 98 98
87 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 98 98 98 98 98 98 98
88 94 94 94 94 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 99
89 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 99 99 99
90 95 95 95 95 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99
91 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99
92 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99
93 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100
94 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100
95 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100
96 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100
97 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100 100 100 100 100 100
98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
99 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
213
PART 2
DEFENCE-RELATED CLAIMS FOR

PERMANENT IMPAIRMENT
214
PART 2
CONTENTS

GLOSSARY 221
DIVISION 1—IMPAIRMENT 223
1. Cardio-vascular system 223
2. Respiratory system 227
3. Endocrine system 229
4. Skin disorders 230
5. Psychiatric conditions 233
6. Visual system 235
7. Ear, nose and throat disorders 236
8. Digestive system 238
9. Musculo-skeletal system 243
10. Urinary system 250
11. Reproductive system 252
12. Neurological function 255
13. Miscellaneous 261
DIVISION 2—NON-ECONOMIC LOSS 267
Introduction 267
Table 1: pain and suffering 267
Table 2: loss of amenities 268
Mobility 268
Social relationships 269
Recreation and leisure activities 269
Table 3: Other loss 270
Table 4: Loss of expectation of life 270
Table 5: Combined value calculation 271
Table 6: Final calculation 272
215
PART 2
LIST OF TABLES AND FIGURES
DIVISION 1—ASSESSMENT OF DEGREE AND EMPLOYEE’S PERMANENT IMPAIRMENT RESULTING FROM INJURY
1. CARDIO-VASCULAR SYSTEM 8. DIGESTIVE SYSTEM

Table 1.1: Assessments of symptomatic activity levels 223 Table 8.1: Disorders of the oesophagus, stomach,
Table 1.2: Peripheral vascular disease 224 duodenum, small intestine, pancreas, colon,
rectum and anus 238
Table 1.3: Varicose veins, deep venous thrombosis,
oedema, ulceration 225 Table 8.2: Disorders of the liver and biliary tract 240
Table 8.3: Fistulae and herniae 242
2. RESPIRATORY SYSTEM
Table 2.1: Ventilatory function 227 9. MUSCULO-SKELETAL SYSTEM
Figure 2.1: Prediction nomogram—males 228 Table 9.1: Upper extremity 244
Figure 2.2: Prediction nomogram—females 228 Table 9.2: Lower extremity 245
Table 9.3: Amputations and/or total loss of function 246
3. ENDOCRINE SYSTEM
Table 9.4: Limb function—upper limb 248
Table 3.1: Endocrine system 229
Table 9.5: Limb function—lower limb 248
4. DISFIGUREMENT AND SKIN DISORDERS Table 9.6: Spine 249
Table 4.1: Functional loss 230
10. URINARY SYSTEM
Table 4.2: Facial disfigurement 231
Table 10.1: Upper urinary tract 250
5. PSYCHIATRIC DISORDERS Table 10.2: Lower urinary tract 251
Table 5.1: Personality disorders, psychoneuroses,
11. REPRODUCTIVE SYSTEM
psychoses, etc 233
Table 11.1: Male 252
6. VISUAL SYSTEM Table 11.2: Female 254
Table 6.1: Disorders of visual acuity 235 Table 11.3: Mammary glands 255
7. EAR, NOSE AND THROAT DISORDERS

Table 7.1: Hearing 236
Table 7.2: Miscellaneous ear, nose and throat disorders 237
216
PART 2 PART 2
LIST OF TABLES AND FIGURES LIST OF REFERENCES
(continued)
12. NEUROLOGICAL FUNCTION Kamburoff Petia L and Woitowitz HJ & RH (1972).
Table 12.1: Cranial nerves 256
American Medical Association, 2001, Guides to the Evaluation of
Table 12.2: Comprehension 257 Permanent Impairment, 5th edition, Chicago: American Medical
Table 12.3: Expression 258 Association.
Table 12.4: Memory 259
Table 12.5: Reasoning 260
13. MISCELLANEOUS
Table 13.1: Intermittent conditions 261
Table 13.2: Malignancies 262
14. COMBINED VALUES CHART

DIVISION 2—NON-ECONOMIC LOSS

Table 1: pain and suffering 267
Table 2: loss of amenities 268
Table 4: Loss of expectation of life 270
Table 5: Combined value calculation 271
Table 6: Final calculation 272
217
PART 2
PRINCIPLES OF ASSESSMENT
1. IMPAIRMENT AND NON-ECONOMIC LOSS 218

2. EMPLOYABILITY AND INCAPACITY 218
3. PERMANENT 218
4. THE IMPAIRMENT TABLES 219
5. GRADATIONS OF IMPAIRMENT 219
6. COMBINED IMPAIRMENTS 219
7. DOUBLE ASSESSMENT 219
8. FINGERS AND TOES 220
9. INAPPLICABILITY OF PART 2 OF THIS GUIDE 220
10. INTERIM ASSESSMENTS 220
11. APPLICATION OF PART 2 OF THE GUIDE 220
12. LIKELIHOOD OF REDUCTION IN DEGREE OF IMPAIRMENT 221
13. AGGRAVATION 221
218
1. IMPAIRMENT AND NON-ECONOMIC LOSS aware of the losses suffered. While employees may have equal
ratings of impairment it would not be unusual for them to receive
Impairment means ‘the loss, loss of use, damage or
different ratings for non-economic loss because of their different
malfunction, of any part of the body, bodily system or function
lifestyles.
or part of such system or function’. It relates to the health status
of an individual and includes anatomical loss, anatomical
2. EMPLOYABILITY AND INCAPACITY
abnormality, physiological abnormality and psychological
abnormality. Throughout this guide emphasis is given to loss The concepts of ‘employability’ and ‘incapacity’ are not included
of function as a basis of assessment of impairment and as far in the assessment of impairment and non-economic loss.
as possible objective criteria have been used. The degree of Incapacity is influenced by factors other than the degree of
impairment is assessed by reference to the impact of that loss impairment and is compensated by weekly payments which are
by reference to the functional capacities of a normal healthy in addition to these payments.
person.
Impairment is measured against its effect on personal efficiency 3. PERMANENT

in the ‘activities of daily living’ in comparison with a normal
Permanent means ‘likely to continue indefinitely’. In determining
healthy person. The measure of ‘activities of daily living’ is a
whether an impairment is permanent regard shall be had to:
measure of primary biological and psychosocial function such
as standing, moving, feeding and self care. 1 the duration of the impairment
2 the likelihood of improvement in the employee’s condition
Non-economic loss, which is assessed in accordance with Part
2, Division 2 of this guide, is a subjective concept of the effects 3 whether the employee has undertaken all reasonable
of the impairment on the employee’s life. It includes pain and rehabilitative treatment for the impairment
suffering, loss of amenities of life, loss of expectation of life and
4 any other relevant matters.
any other real inconveniences caused by the impairment.
An impairment will generally be regarded as permanent when
Whilst ‘activities of daily living’ are used to assess impairment
the recovery process has been completed, i.e. when the full and
they should not be confused with ‘lifestyle effects’ which are
final effects of convalescence, the natural healing process and
used to assess non-economic loss. ‘Lifestyle effects’ are
active (as opposed to palliative) medical treatment has been
a measure of an individual’s mobility and enjoyment of,
achieved.
and participation in, recreation, leisure activities and social
relationships. It is emphasised that the employee must be
219
4. THE IMPAIRMENT TABLES to the condition, which includes performing activities of daily
living and an estimate of the degree to which the medical
Part 2, Division 1 of this guide is based on the concept of
impairment interferes with these activities. In some cases,
‘whole person impairment’ which is drawn from the American
additional information may be required to determine where to
Medical Association’s Guides.
place an individual within the range. The person conducting
Evaluation of a whole person impairment is a medical appraisal the assessment must provide written reason why he or she
of the nature and extent of the effect of an injury or disease on a considers the selected point within the range as clinically
person’s functional capacity and activities of daily living. justifiable.
As with the American Medical Association’s Guides, Part 2,

6. COMBINED IMPAIRMENTS
Division 1 of this guide is structured by assembling detailed
descriptions of impairments into groups according to body Impairment is system or function based. A single injury may
system and expressing the extent of each impairment as a give rise to multiple loss of function. When more than one table
percentage value of the functional capacity of a normal healthy applies to a single injury separate scores should be allocated
person. Thus a percentage value can be assigned to an to each functional impairment. Where there is an initial injury
employee’s impairment by reference to the relevant description in which results in impairment, and a second injury which results
this guide. in impairment to the same bodily system or function occurs, the
pre-existing impairment must be disregarded when assessing
5. GRADATIONS OF IMPAIRMENT the degree of impairment of the second injury. The second injury
should be assessed by reference to the functional capacities of a
Each table contains impairment values at gradations of 5% normal healthy person. The final scores are then added together.
or multiples of five percent. Where it is not clear which of two
impairment values is more appropriate, the relevant authority
7. DOUBLE ASSESSMENT
has the discretion to determine which value properly reflects the
degree of impairment. The possibility of double assessment for a single loss of
function must be guarded against. For example, it would be
There is no discretion to choose an impairment value not
inappropriate to assess a lower limb amputation by reference to
specified in Part 2 of this guide. For example, where 10% and
both the amputation table 9.3 and the lower extremity Table 9.2
20% are specified values there is no discretion to determine
in Part 2, Division 1 of this guide.
impairment as 15%.
Where a table provides for impairment values within a range,

consideration will need to be given to all criteria applicable
220
Where an employee suffers from more than one impairment Assessment for an interim payment will apply mainly in cases
arising from the same injury, the values are not added but undergoing active treatment where the final outcome of the
are combined using the Part 2 combined values table. The treatment is not known but a minimum permanent impairment
purpose of this table is to give the total effect of all impairments, can be measured. Care should be taken to ensure that further
according to a formula, as a percentage value of the employee’s treatment will not reduce the impairment which must be at
whole bodily system or function. least 10%. Interim payment will generally not apply where
the impairment has stabilised or where the only change in
8. FINGERS AND TOES impairment would be due to progressive degeneration.
Impairment relating to the loss or injury to a finger or toe refers

11. APPLICATION OF PART 2 OF THE GUIDE
not only to amputation or total loss of efficient use of the whole
digit, but also to partial loss of efficient use of a digit. This part deals with the assessment of defence-related claims as
defined in Part XI of the SRC Act. That is, claims made under the
9. INAPPLICABILITY OF PART 2 OF THIS GUIDE SRC Act by members of the Defence Force in relation to injuries
which occurred during defence service before 1 July 2004.
In the unlikely event that an employees’ impairment is of a kind
that cannot be assessed in accordance with the provisions The responsibility for development of any Guide that applies
of part 2 of this guide, the relevant authority may direct that to members of the Defence Force in respect of injuries incurred
assessment be made under the provisions of the American after the commencement of the Military Rehabilitation and
Medical Association’s Guides to the Evaluation of Permanent Compensation Act 2004 (MRC Act) will fall to the Department of
Impairment, 5th edition, 2001. Veterans Affairs.
The fact that an injury occurred before 1 December 1988

10. INTERIM ASSESSMENTS does not disqualify a claimant from access to a payment for
permanent impairment.
To ensure that the possibility of entitlement to a permanent
impairment payment does not impede the rehabilitation process > if the impairment became permanent prior to 1 December
provision is made for interim assessment and payment of 1988 entitlement is assessed under the Compensation
compensation. Commonwealth Government Employees Act 1971
> if the impairment became permanent after 1 December
1988 entitlement is assessed under the SRC Act unless it is
to be assessed under the MRC Act.
221
GLOSSARY
12. LIKELIHOOD OF REDUCTION IN DEGREE OF IMPAIRMENT Activities of daily living are those activities that an employee
needs to perform to function in a non-specific environment, i.e.
The relevant authority shall have regard to medical opinion
to live. The measure of activities of daily living is a measure of
concerning the nature and effect (including possible effect) of
primary biological and psychosocial function. They are:
the injury and the extent (if any) to which impairment resulting
from the injury or non-economic loss resulting from the injury > Ability to receive and respond to incoming stimuli
or impairment, may reasonably be capable of being reduced > Standing
or removed. In particular, regard shall be had to an employee’s
> Moving
unreasonable failure or refusal to act in accordance with medical
advice or to submit to medical treatment which would reduce the > Feeding (includes eating but not the preparation of food)
degree of impairment.
> Control of bladder and bowel
> Self care (bathing, dressing etc)
13. AGGRAVATION
> Sexual function.
A permanent impairment assessment in respect of an
aggravation should not be made unless the effects of an Ailment means any physical or mental ailment, disorder, defect
aggravation are considered permanent. If the employee’s or morbid condition (whether of sudden onset or gradual
impairment is entirely attributable to a pre-existing or underlying development).
condition, or to the natural progression of such a condition the
Disease means:
assessment for permanent impairment should be nil.
(a) an ailment suffered by an employee
Where it is possible to isolate the compensable effects of
an injury upon a pre-existing or underlying condition the (b) an aggravation of such an ailment
assessment of the degree of permanent impairment should
that was contributed to, to a significant degree, by the
reflect only the impairment due to those compensable effects.
employee’s employment by the Commonwealth or a licensee.
Impairment means the loss, the loss of the use, or the damage
or malfunction, of any part of the body or of any bodily system
or function or part of such system or function.
222
Injury means: Whole person impairment is the methodology used for
expressing the degree of impairment of a person, resulting
(a) a disease suffered by an employee
from an injury, as a percentage and is drawn from the
(b) an injury (other than a disease) suffered by an employee, American Medical Association Guides to the Evaluation of
that is a physical or mental injury arising out of, or in the Permanent Impairment where it is there referred to as ‘whole
course of, the employee’s employment man’ impairment. Evaluation of whole person impairment is
(c) an aggravation of a physical or mental injury (other than a medical appraisal of the nature and extent of the effect of an
a disease) suffered by an employee (whether or not that injury or disease on a person’s functional capacity and on the
injury arose out of, or in the course of, the employee’s activities of daily living. The guides are structured by assembling
employment), that is an aggravation that arose out of, or detailed descriptions of impairments into groups according to
in the course of, that employment body system and expressing the extent of each impairment
as a percentage value of the functional capacity of a normal
but does not include a disease, injury or aggravation suffered healthy person. Thus, a percentage value can be assigned to an
as a result of reasonable administrative action taken in a employee’s impairment by reference to the relevant description in
reasonable manner in respect of the employee’s employment. this guide.
Loss of amenities means the effects on mobility, social

relationships and recreation and leisure activities.
Non-economic loss means loss or damage of a non-economic

kind suffered by the employee (including pain and suffering, a
loss of expectation of life or a loss of the amenities or enjoyment
of life) of which the employee is aware.
Pain and suffering includes physical pain as well as mental

distress resulting from the accepted conditions or impairment.
For example, grief, anguish, fear, frustration, humiliation,
embarrassment etc.
223
PART 2
DIVISION 1—IMPAIRMENT
1. CARDIO-VASCULAR SYSTEM
Table 1.1: Assessments of symptomatic activity levels
(Percentage whole person impairment)
Table of metabolic costs of activities will be provided for purposes of assessment. Examples of conditions with which it can be used
are ischaemic heart disease, rheumatic heart disease and hypertension.
Male
Symptomatic level of activity (in METs)

AGE
1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 10+
(Yrs)
18-30 95 80 70 60 50 45 35 25 10 5
31-40 95 80 70 60 50 40 30 15 5 -
41-50 95 75 65 50 40 25 15 5 - -
51-60 95 75 60 45 30 15 10 5 - -
61-70 95 70 55 40 25 10 5 - - -
70+ 95 65 45 30 10 - - - - -
224
Female
Symptomatic level of activity (in METs)

AGE
1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 10+
(Yrs)
18-30 95 80 65 60 40 25 15 10 5 -
31-40 95 80 60 45 35 20 5 - - -
41-50 95 75 60 45 30 15 5 - - -
51-60 95 75 55 35 20 10 5 - - -
61-70 95 70 45 30 10 5 - - - -
70+ 95 65 30 15 5 - - - - -
Table 1.2: Peripheral vascular disease
% Description of level of impairment

0 The claimant experiences neither intermittent claudication nor ischaemic pain at rest.
5 The claimant has no difficulty with distances but experiences ischaemic pain on climbing steps or gradients.
10 The claimant experiences claudication on walking 200 metres or more at an average walking pace on level ground.
The claimant experienced claudication on walking more than 100 but less than 200 metres at average pace on level
20
ground.
The claimant experiences claudication on walking more than 75 but less than 100 metres at average pace on level
30
ground.
40 The claimant experiences claudication on walking more than 50 but less than 75 metres at average pace on level ground.
50 The claimant experiences claudication on walking more than 25 but less than 50 metres at average pace on level ground.
60 The claimant experiences claudication on walking less than 25 metres at average pace on level ground.
70 The claimant experiences ischaemic pain at rest.
225
Table 1.3: Varicose veins, deep venous thrombosis, oedema, ulceration

One or more of the following:
> varicose veins—may be gross but cause no significant restriction of activities
0 > oedema—mild or transient
> skin reaction—mild or transient
and minimal limitation of activities of daily living (although exacerbation may temporarily increase the extent of limitation).
Any one of the following which necessitates intermittent treatment including a short period of admission to hospital or
confinement to home:
10 > varicose veins—with recurrent superficial phlebitis
> oedema—persistent and incompletely controlled
> ulceration—superficial, transient.
Any two of the following which necessitate intermittent treatment including a short period of admission to hospital or
confinement to home:
All of the following which necessitate intermittent treatment including a short period of admission to hospital or confinement
to home:

226

Any one of the following which needs continuous treatment including periodic admission to hospital or confinement to
residence:
30 > deep venous thrombosis
> oedema—marked and only partly controlled by elastic support or medication
> ulceration—persistent, widespread or deep.
Any two of the following which need continuous treatment including periodic admission to hospital or confinement to
residence:
40 > deep venous thrombosis
> oedema—marked and only partly controlled by elastic support or medication
> ulceration—persistent, widespread or deep.
Severe bilateral deep venous thrombosis which needs continuous treatment including long periods of admission to hospital
50
or confinement to residence.
Any two of the following which need continuous treatment including long periods of admission to hospital or confinement
to residence:
60 > severe bilateral deep venous thrombosis
> marked oedema that cannot be controlled
> severe ulceration.
227
2. RESPIRATORY SYSTEM Notes:
X-rays may be normal in any of the above categories.

Table 2.1: Ventilatory function
Measurement of FEV1 and Forced Vital Capacity (FVC) should
(Percentage whole person impairment) be performed with a Vitalograph® spirometer or equivalent
instrument. Three readings should be taken and the largest of
The major test of respiratory impairment is the ventilatory
these used to calculate impairment.
function test or respiratory test. Predictive nomograms for the
forced expiratory volume over one second (FEV1) and the
forced vital capacity (FVC) are at Figures 2.1 (males) and 2.2
(females).
% Ventilatory function % of predicted value

0 More than 85
10 85
15 80
20 75
25 70
30 65
35 60
40 55
45 50
50 45
55 40
60 35
65 30
70 25
228
Figure 2.1: Prediction nomogram—males Figure 2.2: Prediction nomogram—females
Kamburoff Petia L, and Woitowitz H.J. & R.H. (1972) Kamburoff Petia L, and Woitowitz H.J. & R.H. (1972)
Males BTPS
Females BTPS
Height FVC FEV1 Age Height FVC FEV1
(cm)(inches) (litre) (litre) (yrs) (cm)(inches) (litre) (litre) Age
(yrs)
190 20
180 20
74
70
73
6 69
72 5
68
4
180 71 30
170 67 30
70
66
69 3
5 65
68
4 64
170 67 40
160 63 40
66
62
65 3
4 61
64
60
3
160 63 50 150 59 50
62 2
58
61
57
3
60
56
150 59 60 2
2 140 60
58
57
56 2
140 70
70
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3. ENDOCRINE SYSTEM
Table 3.1: Endocrine system
The effects of diabetes mellitus in other systems (for example, the vascular and visual systems) should be assessed from the
appropriate tables and combined with values from the table below using the combined values table (Table 14.1).

> thyroid disease adequately controlled with thyroxine replacement
0 > primary hyperparathyroidism; parathyroid adenoma removed; replacement therapy not indicated
> asymptomatic Paget’s disease
> asymptomatic osteoporosis or other bone disease, with or without treatment.
5 Diabetes mellitus satisfactorily controlled by diet and/or oral medication
> thyroid disease which cannot be adequately treated with thyroxine
> primary hyperparathyroidism; parathyroidectomy; replacement therapy required
10
> symptomatic Paget’s disease
> symptomatic osteoporosis
> other bone disease WITH pain not completely controlled by continuous therapy.
15 Diabetes mellitus requiring dietary adjustment and insulin.
20 Diabetes mellitus not satisfactorily controlled despite vigorous therapy.
230
4. SKIN DISORDERS
Table 4.1: Functional loss
In the evaluation of impairment resulting from a skin disorder the actual functional loss is the prime consideration, rather than the
extent of cutaneous involvement. Where the condition affects the face Table 4.2 may be more appropriate.

The condition is absent on examination or if present can easily be reversed by appropriate medication or other treatment
0
and causes no interference with activities of daily living when present.
5 The condition requires treatment for lengthy periods but causes no interference with activities of daily living when present.
The condition is absent on examination or if present can easily be reversed by appropriate medication or treatment and
10
causes minor interference with activities of daily living when present.
The condition requires treatment for periods in aggregate up to three months per year and causes interference with activities
20
of daily living when present.
The condition requires treatment for periods in aggregate up to four months per year and causes minor interference with
30
activities of daily living when present.
The condition requires treatment for periods in aggregate up to four months per year and causes major interference with
40
The condition requires treatment for periods in aggregate up to six months per year and causes minor interference with
45
The condition requires treatment for periods in aggregate up to six months per year and causes major interference with
50
The condition requires treatment for periods in aggregate up to nine months per year and causes major interference with
60
The condition requires treatment for periods in aggregate up to nine months per year and causes major interference with
70
75 - The condition is present all the time and requires treatment for between 9 and 12 months of the year and causes major
100 interference with activities of daily living.
231
Notes to Table 4.1
When evaluating impairment due to facial injury or disease, three factors need to be considered.
First, the functional components of the face must be evaluated (for example the effects of the condition on communication, respiration,
eating, visual function, hearing, etc).
Second, the cosmetic effects should be considered. These are not truly an impairment, but for the purposes of evaluation are deemed
to be equivalent to certain impairments. These deemed values are set out below. Cosmetic defects should be assessed when all
feasible cosmetic surgery has been completed and should take into account the beneficial effects of the use of cosmetics etc.
Third, facial disfigurement may result in behavioural changes. These should be assessed in accordance with the criteria in Table 5.1
‘Psychiatric and Behavioural Disorders’.
Where more than one deformity is present from the same band or different bands, a value should be allotted to each and these should
be combined using the Combined Values Table (see Appendix 1).
232
Normal facial appearance
0 or
any scarring above the brow line.
Any of the following:
> cutaneous scars or pigmentation
5 > unilateral facial paralysis
> distortion of the nose
> loss or deformity of the external ear.
> disfigurement of the orbit
> bilateral facial paralysis
10
> depression of the zygoma
> depression of the frontal bones
> severe scarring below the upper lip.
15 Loss of part of nose.
25 Loss of the entire nose.
35 Severe disfigurement of the entire area between the brow and the upper lip on both sides.
233
5. PSYCHIATRIC CONDITIONS
Table 5.1: Personality disorders, psychoneuroses, psychoses, etc
Includes psychoses, neuroses, personality disorders and other diagnosable conditions. The assessment should be made on optimum
medication at a stage where the condition is reasonably stable.

Reactions to stresses of daily living WITHOUT loss of personal or social efficiency AND retained capability of performing
0
activities of daily living without supervision or assistance.
Despite the presence of ONE of the following, employee is capable of performing activities of daily living without
> lack of conscience-directed behaviour without harm to others or self
> minor distortion of thinking.
Despite the presence of more than one of the following, employee is capable of performing activities of daily living without
> lack of conscience-directed behaviour without harm to others or self
> minor distortion of thinking.
Any of the following, accompanied by a need for some supervision and direction in activities of daily living:
15
Any two of the following, accompanied by a need for some supervision and direction in activities of daily living:
20
> marked disturbance in thinking

234

All of the following, accompanied by a need for some supervision and direction in activities of daily living:
25
> definite disturbances in behaviour.
Any one of the following, accompanied by a need for supervision and direction in activities of daily living:
30 > hospital dischargees who require daily medication or regular therapy to avoid readmission
> loss of self control and/or inability to learn from experience causing considerable damage to self or others.
Both one of the following, accompanied by a need for supervision and direction in activities of daily living:
40 > hospital dischargees who require daily medication or regular therapy to avoid readmission
> loss of self control and/or inability to learn from experience causing considerable damage to self or others.
50 > severe disturbances of thinking and/or behaviour which entails potential or actual harm to self and/or others
Both of the following
60 > severe disturbances of thinking and/or behaviour which entails potential or actual harm to self and/or others
Very severe disturbance in all aspects of thinking and behaviour such as to require constant supervision and care in a
90
confined environment and assistance with all activities of daily living.
235
6. VISUAL SYSTEM
Table 6.1: Disorders of visual acuity
Disorders such as nystagmus, conjunctivitis, impaired colour vision, night blindness and glaucoma (without visual loss) are usually
binocular and cause minimal impairment. An assessment of 0 to 5 percent is appropriate for such conditions.
Visual field defects should be accurately mapped and assessed in accordance with the procedures dictated in the 2nd edition of the
American Medical Association’s Guides to the Evaluation of Permanent Impairment.
Impairment is based on corrected visual acuity.
Right eye
6/6 6/9 6/12 6/18 6/24 6/30 6/36 6/48 6/60 3/60 NPL
6/6 0 5 5 10 10 15 15 20 20 20 25
6/9 5 10 10 15 15 20 20 25 25 30 30
6/12 5 10 20 20 25 25 30 30 35 35 40
6/18 10 15 20 30 30 35 35 40 40 40 45
6/24 10 15 25 30 40 40 40 45 45 50 50
Left eye
6/30 15 20 25 35 40 45 50 50 55 55 60
6/36 15 20 30 35 40 50 55 60 60 65 65
6/48 20 25 30 40 45 50 60 65 70 70 75
6/60 20 25 35 40 45 55 60 70 75 80 80
3/60 20 30 35 40 50 55 65 70 80 85 85
NPL 25 30 40 45 50 60 65 75 80 85 85
Note: NPL means no perceived light.

236
7. EAR, NOSE AND THROAT DISORDERS
Table 7.1: Hearing
Hearing defects are assessed in accordance with the current procedures from the Australian National Acoustic Laboratories.
Once the binaural percentage loss of hearing has been calculated, it is then converted to a whole person impairment value.
The calculation for converting the percentage loss of hearing to a whole person percentage is:
(Percentage loss of hearing)
2
237
Table 7.2: Miscellaneous ear, nose and throat disorders

One or more of the following:
> intermittent otorrhoea
> intermittent otalgia and tinnitus
0
> post nasal discharge, rhinorrhoea and sneezing
> vertigo which does not interfere with any activities
> other conditions which are controlled by medication or for which no medication is required.
> permanent otorrhoea
5
> complete loss of olfaction or taste
> permanent tinnitus.
> permanent otalgia
10
> vertigo which interferes only with activities involving personal or public safety (for example, driving a car, operating
machinery).
20 Vertigo which interferes with activities of daily living.
25 Permanent tracheostomy or stoma.
40 Vertigo which interferes with all activities except household duties and self care.
Vertigo which interferes with all activities to the extent that only self care can be managed and all other activity is
60
impossible.
80 Vertigo such that the sufferer is confined to home and requires assistance with all activities, including self care.
238
8. DIGESTIVE SYSTEM
Table 8.1: Disorders of the oesophagus, stomach, duodenum, small intestine, pancreas, colon, rectum and anus

0 Symptoms present but no anatomical loss or alteration.
Symptoms and/or signs present and there is anatomical loss or alteration but continuous treatment is not required and
weight and nutrition are maintained at normal levels
5
or
mild incontinence of flatus or liquid stool.
Objective signs of disease present and at least one of the following:
> dietary modification needed for control
10
> drugs needed for control
> weight loss of up to 10% of desirable weight per range on standard BMI chart.
Objective signs of disease present and at least two of the following:
15
Partial faecal incontinence requiring continual treatment
or
objective signs of disease present and all of the following:
20

239

Objective signs of disease present and one of the following:
25 > dietary modification and drugs produce partial but incomplete control
> weight loss of 10 to 20% of desirable weight per range on standard BMI chart.
Objective signs of disease present and both of the following:
30 > dietary modification and drugs produce partial but incomplete control
> weight loss of 10 to 20 percent of desirable weight per range on standard BMI chart.
Objective signs of disease present with two of the following:
> disturbed bowel habit
40 > pain (periodic or continual)
> continual manifestations (for example, fever or anaemia)
45 Complete faecal incontinence
Objective signs of disease present with all of the following:
> disturbed bowel habit
50 > pain (periodic or continual)
> continual manifestations (for example, fever or anaemia)
Objective signs of disease present and a combination of the following:
> severe persistent disturbance of bowel habit
55 - > severe persistent pain
77 > constitutional manifestations
> weight loss of more than 20 percent of desirable weight per range on standard BMI chart
> severe limitation of activity.
Notes to Table 8.1

240
Table 8.2: Disorders of the liver and biliary tract

0 Mildly abnormal liver function tests but adequate nutrition and strength with no other signs of disease.
5 Episodes of biliary colic twice a year or less frequently.
Stigmata of liver disease but no history of jaundice, ascites or bleeding oesophageal varices within the last five years.
10 and
Liver function tests normal or mildly abnormal.
15 Episodes of biliary colic three to five times a year.
Stigmata of liver disease with jaundice, ascites or bleeding oesophageal varices one to five years ago and liver function
20
tests now normal or mildly abnormal.
Stigmata of liver disease with jaundice, ascites or bleeding oesophageal varices one to five years ago and liver function
25
tests markedly abnormal.
Stigmata of liver disease with jaundice, ascites or bleeding oesophageal varices in the past year
40 or
objective signs of progressive liver disease.
50 Permanent irreparable biliary tract obstruction.
Objective signs of progressive liver disease with one of the following:
> persistent jaundice
60
> frequent, recurrent bleeding episodes
> central nervous system manifestations of hepatic insufficiency.

241

Objective signs of progressive liver disease with two of the following:
70
Objective signs of progressive liver disease with all of the following:
80
95 Hepatic coma.
242
Table 8.3: Fistulae and herniae

5 > inguinal hernia (readily reducible)
> ventral hernia, well supported.
10 > small recurrent inguinal hernia (operable but not readily reducible)
> colostomy.
> large recurrent inguinal hernia (inoperable and not readily reducible)
15 > oesophagostomy
> gastrostomy
> ventral hernia, not well supported.
> massive ventral hernia (inoperable, with severe diastasis of recti)
20
> jejunostomy
> ileostomy.
243
9. MUSCULO-SKELETAL SYSTEM
Introduction
These tables are intended to be used to assess impairment arising from specific joint lesions or amputations. Where the joints
function normally but the use of a limb is restricted for other reasons, eg soft tissue injury, nerve injury or bony injury not involving
joints, Tables 9.4 or 9.5 should be used. These Tables can be used to assess the impairment of overall limb function from any cause.
Note: either the musculo-skeletal table or Table 9.4 or 9.5 should be used—not both.
Assessment is in accordance with the range of joint movement. X-rays should not be taken solely for assessment purposes.
244
Table 9.1: Upper extremity
Values are for one joint only. Where more than one joint is affected, values should be combined using the combined values table
(Table 14.1).

0 X-ray changes but no loss of function of shoulder, elbow or wrist.
5 > x-ray changes with minimal loss of function of shoulder, elbow or wrist
> ankylosis of any joint of ring and/or small finger(s).
> loss of less than half normal range of movement of shoulder or elbow
10
> loss of half normal range of movement of wrist
> ankylosis of any joints of index and/or middle finger(s).
15 > loss of more than half normal range of movement of wrist
> ankylosis of any joint(s) of thumb.
20 > loss of half normal range of movement of shoulder or elbow
> ankylosis of wrist.
30 Loss of more than half normal range of movement of shoulder or elbow.
40 Ankylosis of shoulder or elbow.
245
Table 9.2: Lower extremity
Assessment is in accordance with the range of joint movement. X-rays should not be taken solely for assessment purposes.
Where a joint has been surgically replaced assessment is in accordance with its function.
Shortening of the lower extremity by 2.5cm or more is in impairment of 5%.
For conditions not covered (such as flail joints) the assessor should have regard to the loss of function (not exceeding the maximum
allowed for amputation).
Values are for one joint only. Where more than one joint is affected, values should be combined using the combined values table
(Appendix 1).

X-ray changes but no loss of function of hip, knee or ankle
0 or
ankylosis or lesser changes in any toes except the hallux.
5 Loss of less than half normal range of movement of ankle.
> loss of less than half normal range of movement of hip or knee
10
> loss of half normal range of movement of ankle
> ankylosis of hallux.
15 Loss of more than half normal range of movement of ankle.
20 > Loss of half normal range of movement of hip or knee
> ankylosis of ankle.
30 Loss of more than half normal range of movement of hip or knee.
40 Ankylosis of hip or knee.
246
Table 9.3: Amputations and/or total loss of function
Impairment relating to the loss of or injury to a finger or toe refers not only to amputation or total loss of efficient use of the whole
digit, but also to partial loss of efficient use of a digit.

> amputation of little finger
> amputation of ring finger
> total loss of movement of any joint of thumb
> amputation of terminal segment of thumb involving one third of its flexor surface without loss of distal phalanx or
5
interphalangeal joint
> amputation of two phalanges or joints of index, middle, ring or little finger
> amputation of two phalanges or joints of middle, ring or little fingers
> amputation of distal phalanx or joint of forefinger
> amputation of distal phalanx or joint of hallux.
> amputation of all toes
10 > amputation of great toe
> amputation of middle finger
> amputation of distal phalanx or joint of thumb.
15 > mid-metatarsal amputation
> amputation of index finger.
20 > partial amputation of the foot (Chopart)
> amputation of the thumb.

247

> amputation below knee with functional stump
30
> amputation at ankle
> amputation of all fingers, but not thumb.
> amputation above knee with functional stump
> disarticulation at knee
40 > Gritti Stokes amputation
> amputation below knee with short stump (7.5 cm or less below intercondylar notch)
> disarticulation at hip joint
> amputation above knee with short stump (7.5 cm or less below tuber ischii).
> hemipelvectomy
50 > amputation of forearm distal to biceps tendon insertion
> disarticulation at wrist joint
> mid-carpal or mid-metacarpal amputation of hand.
> amputation between deltoid insertion and elbow
> disarticulation at elbow
60
> amputation of forearm proximal to biceps tendon insertion
> disarticulation at shoulder
> amputation above deltoid insertion.
70 Forequarter (upper) amputation.
248
Table 9.4: Limb function—upper limb

10 Can use limb for self care and grasping and holding but has difficulty with digital dexterity.
20 Can use limb for self care but has no digital dexterity or has difficulties grasping and holding.
30 Retains some use of limb but has difficulty with self care.
40 Cannot use limb for self care.
Table 9.5: Limb function—lower limb

10 Can rise to standing position and walk but has difficulty with grades and steps.
20 Can rise to standing position and walk but has difficulty with grades, steps and distances.
30 Can rise to standing position and walk with difficulty but is limited to level surfaces.
50 Can rise to standing position and maintain it with difficulty but cannot walk.
65 Cannot stand or walk.
249
Table 9.6: Spine
Lesions of the sacrum and coccyx should be assessed by using the table which most appropriately reflects the functional impairment.
This will usually be Table 9.5.
Lesions of the spine are often accompanied by neurological consequences. These should be assessed using Table 9.4 or 9.5 and the
results combined using the combined values table (Appendix 1).
Description of level of impairment

%
Cervical spine Thoraco-lumbar spine
0 X-ray changes only. X-ray changes only.
Minor restrictions of movement
5 Minor restrictions of movement. or
crush fracture—compression of 25-50 percent.
Loss of less than half normal range of movement
10 Loss of half normal range of movement. or
crush fracture—compression greater than 50 percent.
15 Loss of more than half normal range of movement. Loss of half normal range of movement.
20 Complete loss of movement. Loss of more than half normal range of movement.
30 Complete loss of movement.
250
10. URINARY SYSTEM
Table 10.1: Upper urinary tract

Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 90 litres/day or more
and/or
0
intermittent symptoms or signs of upper urinary tract dysfunction are present that do not require continuous treatment or
surveillance.
Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 75 to 89 litres/day
10 and/or
single kidney.
Creatinine clearance is 75 to 89 litres/day AND symptoms and signs of urinary tract dysfunction or disease necessitate
15
continuous medical treatment.
30 Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 60 to 74 litres/day.
Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 50 to 59 litres/day and
45
symptoms and signs of dysfunction or disease are incompletely controlled by surgical or continuous medical treatment.
Diminution of upper urinary tract function is present as evidenced by creatinine clearance of 40 to 49 litres/day and
65
70 Diminution of upper urinary tract function is present as evidenced by creatinine clearance of less than 40 litres/day.
Diminution of upper urinary tract function is present as evidenced by creatinine clearance of less than 40 litres/day and
75
85 Deterioration of renal function requiring either peritoneal dialysis or haemodialysis.
251

0 Occasional intermittent disorder without interval problems.
Uretheral stricture or other disorder requiring intermittent therapy (for example, passage of sounds at intervals of greater
10
than eight weeks).
Disorder requires continuous treatment
15 or
no voluntary bladder control but good reflex activity.
Urinary diversion with or without removal of the bladder
or
25
uretheral stricture or other disorder which cannot be effectively controlled, or recurs frequently, or requires more frequent
passage of sounds (at intervals of less than four to eight weeks).
30 Intermittent dribbling incontinence.
45 Continuous dribbling incontinence.
252
11. REPRODUCTIVE SYSTEM
Table 11.1: Male
This table is used to assess conditions affecting the testes, prostrate, penis, seminal vesicles, spermatic cord, epididymis and
scrotum (Percentage whole person impairment)

> only one testis present
> symptoms and/or signs of scrotal loss or disease
> scrotal malposition
or
all of the following:
> symptoms and/or signs of testicular, epididymal and/or spermatic cord disease, WITH anatomical alteration
> continuous treatment not required
5
> no seminal or hormonal abnormalities
or
> symptoms and/or signs of prostatic and/or seminal vesicular dysfunction or disease
> anatomical alteration present
> continuous treatment not required
or
> impotence in a claimant aged 65 years or more with intact sexual organs.
10 Sexual function possible but varying degrees of difficulty with erection, ejaculation and/or sensation.

253

> sexual function possible in that there is sufficient erection but no ejaculation or sensation
> testes implanted in other than scrotal position to preserve function and testicular pain or discomfort with activity
> total loss of scrotum
> impotence in a claimant aged between 40 and 64 years with intact sexual organs
or
15 > symptoms and/or signs of testicular, epididymal and/or spermatic cord disease, with anatomical alteration
> continuous or frequent treatment required
> detectable seminal or hormonal abnormalities
or
> frequent severe symptoms and/or signs of prostatic and/or seminal vesicular function or disease
> anatomical alteration present
> continuous treatment required.
No sexual function possible because of any of the following:
> bilateral loss of testes
> no detectable seminal or hormonal function of the testes, epididymis or spermatic cords
20
> ablation of prostate and/or seminal vesicles
or
> impotence in a claimant aged less than 40 years with intact sexual organs.
254
Table 11.2: Female
% Vulva and/or vagina Cervix and/or uterus Fallopian tubes and/or ovaries
Symptoms and/or signs of disease
Symptoms and/or signs of disease or deformity not requiring continuous
or deformity not requiring continuous
or deformity not requiring continuous treatment
treatment
treatment or
or
10 and cervical stenosis not requiring
unilateral dysfunction
sexual intercourse possible treatment
or
and or
bilateral loss in post menopausal
vagina adequate for childbirth. anatomic loss in post menopausal
years.
years.
or deformity requiring continuous
treatment Symptoms and/or signs of disease
or deformity requiring continuous Symptoms and/or signs of disease
and
treatment or deformity requiring continuous
25 sexual intercourse possible with
or treatment but tubes are patent and
varying degrees of difficulty
cervical stenosis requiring periodic ovulation is possible.
and
treatment.
vaginal delivery limited in pre-
menopausal years.
Symptoms and/or signs of disease or Symptoms and/or signs of disease or
deformity not controlled by continuous deformity not controlled by continuous Symptoms and/or signs of disease or
treatment treatment deformity not controlled by continuous
treatment
and or
35 and
sexual intercourse not possible cervical stenosis complete
total loss of tubular patency, or total
and or
failure to produce ova, in the pre-
vaginal delivery not possible in the anatomic or complete functional loss menopausal years.
pre-menopausal years. in the pre-menopausal years.
255
Table 11.3: Mammary glands

Any of the following.
> female of childbearing age with absence of the breasts
10
> male with painful gynaecomastia that interferes with daily activities
> galactorrhoea sufficient to require the use of absorbent pads.
12. NEUROLOGICAL FUNCTION
Neurological function is divided into three sub-groups—cranial nerves (Table 12.1), communication (Tables 12.2 & 12.3) and
cognitive function (Tables 12.4 & 12.5).
Communication and cognitive function are each divided into two sub-sections—the sub-sections of communication are
comprehension (Table 12.2) and expression (Table 12.3); the sub-sections of cognitive function are memory (Table 12.4) and
reasoning (Table 12.5).
Cranial nerves
Please note that assessments for sight, smell and taste can be made under other tables. They have been included here as well so that
this table is complete. Do not make two separate assessments and combine them. Use one or the other. The other relevant tables are
Table 6.1 ‘Visual system’, and Table 7.2 ‘Ear, nose and throat disorders—Miscellaneous’.
256
Table 12.1: Cranial nerves
Criteria
%
Unilateral loss or paralysis Bilateral loss or paralysis Other
I
0 I
XII
5 V (motor) VII (complete loss of taste).
Swallowing impairment due to one or two
XII (swallowing impairment, with diet
10 V (sensory) combinations of IX, X and XI, with diet
restricted to semi-solids).
restricted to semi-solids.
15 VII
20 VII Atypical facial neuralgia.
II
or
25 III, IV, VI alone or in
combination (diplopia
corrected by covering one eye.
30 combinations of IX, X and XI, with diet
restricted to liquids).
restricted to liquids.
35 V (sensory)
45 V (motor)
V Intractable typical trigeminal neuralgia or tic
50
douloureux.
60 combinations of IX, X & XI, and resulting in diet
by tube feeding or gastrostomy.
by tube feeding or gastrostomy.
85 II
257
Tables 12.2 to 12.5 should not be used to assess problems whose origins are genetic, social or educational. Their use is confined to
the assessment of the consequences of neurological injury or disease.
Communication
Notes:
Communication disorders may arise as a result of interference with comprehension and/or expression. They are the result of
neurological damage arising for example from head injury or cerebro-vascular accident. Comprehension may be further divided into
hearing and reading skills and expression into verbal and written skills. A report from a Speech Pathologist or Rehabilitation Specialist
will generally be necessary to enable impairment of this function to be accurately assessed. In all cases the employee’s abilities prior
to the injury or disease must be taken into account. It would be inappropriate to assess an illiterate person with respect to reading
and writing skills. Similarly where English is an employee’s second language, it may be more appropriate to base assessment on
interference with ability to understand and speak the employee’s first language.
Table 12.2: Comprehension

Criteria
%
Hearing Reading
Understands speech in most situations, but has difficulties Reads books and magazine articles, but does not
5
in groups or when fatigued. understand details.
Understands speech in one to one situations, but cannot Can get the gist of simple articles, for example in
10
cope in group situations. newspapers, but has great difficulty with details.
20 Understands only simple sentences.
Understands simple sentences although repetition is
25
sometimes needed.
30 Able to read only single words.
35 Unable to read at all.
40 Able to understand only single words.
50 Unable to understand any language.
258
Notes:
*Hearing refers to the ability to comprehend spoken language—i.e. with the ability to interpret auditory signals, not to receive such
signals. It does not refer to hearing impairment which is assessed using Table 8.1
Table 12.3: Expression
Criteria
%
Verbal Written
Can sustain conversation, but has minor word retrieval problems Can write simple letters, but cannot write complex
5
and/or hesitancy. documents.
Can write postcards and letters of about five lines
Can converse in simple sentences only and may have difficulty with
10 (spelling and grammatical errors may be apparent),
word finding and expressing complex ideas.
but cannot write longer documents.
Can write only short, simple sentences (spelling
15
errors may be evident).
20 Only able to respond in short sentences or phrases. Cannot write sentences, but can write single words.
Able to write or copy only a familiar sequence of
letters, for example own name
25
or
unable to write at all.
30 Limited to use of single words and/or social or stereotyped phrases.
No useful speech (includes unintelligible speech and speech limited
35
to swearing).
259
Table 12.4: Memory
% Criteria
0 No appreciable effect. Reliance on notes, lists etc is comparable to others of same age, education and lifestyle.
Difficulties with names and appointments and tends to misplace objects.
10
There may be partial compensation by reliance on notes, lists, diaries or other people.
Failure to keep appointments or fulfil other obligations despite use of memory aids
25 and
difficulties recalling details of recent events AND tendency to get lost in unfamiliar surroundings.
Failure to keep appointments or fulfil other obligations despite use of memory aids, to a more pronounced extent
40 and
some supervision by another necessary.
Unable to recall recent events or experiences
60 and
constant supervision necessary to avoid harm resulting in inability to live independently.
Unable to recall recent events or experiences, to a more pronounced extent
and
70 disorientation in familiar surroundings
and
inability to recognise familiar faces or objects.
Notes:
Cognitive function has two components—memory and reasoning ability. These functions are affected where there is neurological
damage eg, from head injury, cerebro-vascular accident etc. Difficulties with memory or reasoning ability due to some other process
eg, psychiatric illness should not be assessed using these tables. Instead Table 6.1 should be used.
Assessment should be carried out by a neurologist or clinical psychologist.

260
Table 12.5: Reasoning
% Criteria
0 Abilities intact.
10 Able to cope with routine activities and situations but experiences minor difficulties in new situations.
Still able to cope with routine activities but has moderate difficulties in new
situations
25
and
Complex decision making and abstract thinking are affected.
Major difficulties in new situations
and
40 difficulties with routine activities and problems becoming manifest
and
complex decision making and abstract thinking seriously affected.
Major difficulties in carrying out routine daily activities.
60
Perseverative thinking may be evident.
70 Needs prompting and assistance with even the simplest activities.
Notes: Assessment is carried out by examining the degree of interference with the ability to plan and carry out tasks involving a
number of steps, ability to solve problems and make decisions which involve the examination of new and old material, ability to
think in abstract terms eg, interpret proverbs. Generally complex tasks and decisions will be first affected as will decisions involving
unfamiliar factors.
Assessment should be carried out by a neurologist or clinical psychologist.

261
13. MISCELLANEOUS
Table 13.1: Intermittent conditions
For use in the assessment of disorders of the haemopoietic system such as anaemia, polycythaemia, leukocyte and platelet disorders
and intermittent disorders such as asthma, migraine, tension headache, epilepsy etc.
Principles:
Determine the frequency, duration and severity of attacks with reference to the degree of interference with activities of daily living.

Episodes may be of any frequency but do not interfere with activities of daily living or are readily prevented or reversed by
0
appropriate medication or treatment.
Episodes occur 12 or more times a year and cause minor interference with activities of daily living
10 or
episodes occur less frequently and cause interference with all activities of daily living other than self care.
Episodes occur up to 25 percent of the time and cause significant interference with most activities of daily living other than
20
self care.
30
self care.
40
self care.
Episodes occurup to 50 percent of the time and cause significant interference with most activities of daily living other than
50
self care.
60
self care.
70
self care.
75 - Episodes occur 75 to 100 percent of the time and needs assistance with most or all activities of daily living including self
95 care (confinement to a residential care facility is required for assessed impairment levels of more than 80 percent).
262
Notes:
Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.
Table 13.2: Malignancies

0 No symptoms or evidence of disease and able to undertake normal activities with no special care needed.
10
Some signs or symptoms of disease and normal activities can be undertaken with moderate effort.
-15
35 Does not require institutional care but needs assistance with activities of daily living other than self care.
50 Can still be maintained at home but with considerable assistance and frequent medical care.
65 Requires institutional care and considerable assistance with activities of daily living other than self care.
75 Requires institutional care and considerable assistance with activities of daily living including self care.
85 Intensive support and/or treatment needed (disease may be progressing rapidly).
Notes:
Assessors should refer to the Principles of Assessment for guidance on awarding an impairment value within a range.
263
PART 2
APPENDIX 1
14. COMBINED VALUES CHART
The values are derived from the formula:
A + B(1-A) = combined value of A and B
where A and B are the decimal equivalents of the WPI ratings
In the chart all values are expressed as percentages. To combine

any two impairment values, locate the larger of the values on the
side of the chart and read along that row until you come to the
column indicated by the smaller value at the bottom of the chart.
At the intersection of the row and the column is the combined
value.
For example, to combine 35% and 20%, read down the side
of the chart until you come to the larger value, 35%. Then read
across the 35% row until you come to the column indicated by
20% at the bottom of the chart. At the intersection of the row and
column is the number 48. Therefore, 35% combined with 20%
is 48%. Because of the construction of this chart, the larger
impairment value must be identified at the side of the chart.
If three or more impairment values are to be combined, sort the

impairment values from highest to lowest, select the highest and
second highest, then find their combined values as above. Then
use that combined value and the third highest impairment value
to locate the combined value of all impairments.
This process can be repeated indefinitely, the final value in each

instance being the combination of all the previous values. In
each step of this process the larger impairment value must be
identified at the side of the chart.
Part 2—Appendix 1: Combined values chart
Source: American Medical Association’s Guides to the Evaluation of Permanent Impairment, 5th edition, page 604
1 2
2 3 4
3 4 5 6
4 5 6 7 8
5 6 7 8 9 10
6 7 8 9 10 11 12
7 8 9 10 11 12 13 14
8 9 10 11 12 13 14 14 15
9 10 11 12 13 14 14 15 16 17
10 11 12 13 14 15 15 16 17 18 19
11 12 13 14 15 15 16 17 18 19 20 21
12 13 14 15 16 16 17 18 19 20 21 22 23
13 14 15 16 16 17 18 19 20 21 22 23 23 24
14 15 16 17 17 18 19 20 21 22 23 23 24 25 26
15 16 17 18 18 19 20 21 22 23 24 24 25 26 27 28
16 17 18 19 19 20 21 22 23 24 24 25 26 27 28 29 29
17 18 19 19 20 21 22 23 24 24 25 26 27 28 29 29 30 31
18 19 20 20 21 22 23 24 25 25 26 27 28 29 29 30 31 32 33
19 20 21 21 22 23 24 25 25 26 27 28 29 30 30 31 32 33 34 34
20 21 22 22 23 24 25 26 26 27 28 29 30 30 31 32 33 34 34 35 36
21 22 23 23 24 25 26 27 27 28 29 30 30 31 32 33 34 34 35 36 37 38
22 23 24 24 25 26 27 27 28 29 30 31 31 32 33 34 34 35 36 37 38 38 39
23 24 25 25 26 27 28 28 29 30 31 31 32 33 34 35 35 36 37 38 38 39 40 41
24 25 26 26 27 28 29 29 30 31 32 32 33 34 35 35 36 37 38 38 39 40 41 41 42
25 26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44
26 27 27 28 29 30 30 31 32 33 33 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45
27 28 28 29 30 31 31 32 33 34 34 35 36 36 37 38 39 39 40 41 42 42 43 44 45 45 46 47
28 29 29 30 31 32 32 33 34 34 35 36 37 37 38 39 40 40 41 42 42 43 44 45 45 46 47 47 48
29 30 30 31 32 33 33 34 35 35 36 37 38 38 39 40 40 41 42 42 43 44 45 45 46 47 47 48 49 50
30 31 31 32 33 34 34 35 36 36 37 38 38 39 40 41 41 42 43 43 44 45 45 46 47 48 48 49 50 50 51
31 32 32 33 34 34 35 36 37 37 38 39 39 40 41 41 42 43 43 44 45 45 46 47 48 48 49 50 50 51 52 52
32 33 33 34 35 35 36 37 37 38 39 39 40 41 42 42 43 44 44 45 46 46 47 48 48 49 50 50 51 52 52 53 54
33 34 34 35 36 36 37 38 38 39 40 40 41 42 42 43 44 44 45 46 46 47 48 48 49 50 50 51 52 52 53 54 54 55
34 35 35 36 37 37 38 39 39 40 41 41 42 43 43 44 45 45 46 47 47 48 49 49 50 51 51 52 52 53 54 54 55 56 56
35 36 36 37 38 38 39 40 40 41 42 42 43 43 44 45 45 46 47 47 48 49 49 50 51 51 52 53 53 54 55 55 56 56 57 58
36 37 37 38 39 39 40 40 41 42 42 43 44 44 45 46 46 47 48 48 49 49 50 51 51 52 53 53 54 55 55 56 56 57 58 58 59
37 38 38 39 40 40 41 41 42 43 43 44 45 45 46 46 47 48 48 49 50 50 51 51 52 53 53 54 55 55 56 57 57 58 58 59 60 60
38 39 39 40 40 41 42 42 43 44 44 45 45 46 47 47 48 49 49 50 50 51 52 52 53 54 54 55 55 56 57 57 58 58 59 60 60 61 62
39 40 40 41 41 42 43 43 44 44 45 46 46 47 48 48 49 49 50 51 51 52 52 53 54 54 55 55 56 57 57 58 59 59 60 60 61 62 62 63
40 41 41 42 42 43 44 44 45 45 46 47 47 48 48 49 50 50 51 51 52 53 53 54 54 55 56 56 57 57 58 59 59 60 60 61 62 62 63 63 64
41 42 42 43 43 44 45 45 46 46 47 47 48 49 49 50 50 51 52 52 53 53 54 55 55 56 56 57 58 58 59 59 60 60 61 62 62 63 63 64 65 65
42 43 43 44 44 45 45 46 47 47 48 48 49 50 50 51 51 52 52 53 54 54 55 55 56 57 57 58 58 59 59 60 61 61 62 62 63 63 64 65 65 66 66
43 44 44 45 45 46 46 47 48 48 49 49 50 50 51 52 52 53 53 54 54 55 56 56 57 57 58 58 59 60 60 61 61 62 62 63 64 64 65 65 66 66 67 68
44 45 45 46 46 47 47 48 48 49 50 50 51 51 52 52 53 54 54 55 55 56 56 57 57 58 59 59 60 60 61 61 62 62 63 64 64 65 65 66 66 67 68 68 69
45 46 46 47 47 48 48 49 49 50 51 51 52 52 53 53 54 54 55 55 56 57 57 58 58 59 59 60 60 61 62 62 63 63 64 64 65 65 66 66 67 68 68 69 69 70
46 47 47 48 48 49 49 50 50 51 51 52 52 53 54 54 55 55 56 56 57 57 58 58 59 60 60 61 61 62 62 63 63 64 64 65 65 66 67 67 68 68 69 69 70 70 71
47 48 48 49 49 50 50 51 51 52 52 53 53 54 54 55 55 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 65 66 66 67 67 68 68 69 69 70 70 71 71 72
48 49 49 50 50 51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73
49 50 50 51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 74
50 51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 74 74 75 75
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
51 51 52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 74 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 74 74 75 75 76
52 52 53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 62 62 63 63 64 64 64 65 65 66 66 67 67 68 68 69 69 70 70 71 71 72 72 73 73 74 74 75 75 76 76
53 53 54 54 55 55 56 56 57 57 58 58 59 59 60 60 61 61 61 62 62 63 63 64 64 65 65 66 66 67 67 68 68 69 69 69 70 70 71 71 72 72 73 73 74 74 75 75 76 76 77
54 54 55 55 56 56 57 57 58 58 59 59 60 60 60 61 61 62 62 63 63 64 64 65 65 66 66 66 67 67 68 68 69 69 70 70 71 71 71 72 72 73 73 74 74 75 75 76 76 77 77
55 55 56 56 57 57 58 58 59 59 60 60 60 61 61 62 62 63 63 64 64 64 65 65 66 66 67 67 68 68 69 69 69 70 70 71 71 72 72 73 73 73 74 74 75 75 76 76 77 77 78
56 56 57 57 58 58 59 59 60 60 60 61 61 62 62 63 63 63 64 64 65 65 66 66 67 67 67 68 68 69 69 70 70 71 71 71 72 72 73 73 74 74 74 75 75 76 76 77 77 78 78
57 57 58 58 59 59 60 60 60 61 61 62 62 63 63 63 64 64 65 65 66 66 66 67 67 68 68 69 69 69 70 70 71 71 72 72 72 73 73 74 74 75 75 75 76 76 77 77 78 78 79
58 58 59 59 60 60 61 61 61 62 62 63 63 63 64 64 65 65 66 66 66 67 67 68 68 69 69 69 70 70 71 71 71 72 72 73 73 74 74 74 75 75 76 76 76 77 77 78 78 79 79
59 59 60 60 61 61 61 62 62 63 63 64 64 64 65 65 66 66 66 67 67 68 68 68 69 69 70 70 70 71 71 72 72 73 73 73 74 74 75 75 75 76 76 77 77 77 78 78 79 79 80
60 60 61 61 62 62 62 63 63 64 64 64 65 65 66 66 66 67 67 68 68 68 69 69 70 70 70 71 71 72 72 72 73 73 74 74 74 75 75 76 76 76 77 77 78 78 78 79 79 80 80
61 61 62 62 63 63 63 64 64 65 65 65 66 66 66 67 67 68 68 68 69 69 70 70 70 71 71 72 72 72 73 73 73 74 74 75 75 75 76 76 77 77 77 78 78 79 79 79 80 80 81
62 62 63 63 64 64 64 65 65 65 66 66 67 67 67 68 68 68 69 69 70 70 70 71 71 72 72 72 73 73 73 74 74 75 75 75 76 76 76 77 77 78 78 78 79 79 79 80 80 81 81
63 63 64 64 64 65 65 66 66 66 67 67 67 68 68 69 69 69 70 70 70 71 71 72 72 72 73 73 73 74 74 74 75 75 76 76 76 77 77 77 78 78 79 79 79 80 80 80 81 81 82
64 64 65 65 65 66 66 67 67 67 68 68 68 69 69 69 70 70 70 71 71 72 72 72 73 73 73 74 74 74 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 81 81 81 82 82
65 65 66 66 66 67 67 67 68 68 69 69 69 70 70 70 71 71 71 72 72 72 73 73 73 74 74 74 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 81 81 81 82 82 83
66 66 67 67 67 68 68 68 69 69 69 70 70 70 71 71 71 72 72 72 73 73 73 74 74 75 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 81 81 81 82 82 82 83 83
67 67 68 68 68 69 69 69 70 70 70 71 71 71 72 72 72 73 73 73 74 74 74 75 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 81 81 81 82 82 82 83 83 83 84
68 68 69 69 69 70 70 70 71 71 71 72 72 72 72 73 73 73 74 74 74 75 75 75 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 80 81 81 81 82 82 82 83 83 83 84 84
69 69 70 70 70 71 71 71 71 72 72 72 73 73 73 74 74 74 75 75 75 76 76 76 76 77 77 77 78 78 78 79 79 79 80 80 80 80 81 81 81 82 82 82 83 83 83 84 84 84 85
70 70 71 71 71 72 72 72 72 73 73 73 74 74 74 75 75 75 75 76 76 76 77 77 77 78 78 78 78 79 79 79 80 80 80 81 81 81 81 82 82 82 83 83 83 84 84 84 84 85 85
71 71 72 72 72 72 73 73 73 74 74 74 74 75 75 75 76 76 76 77 77 77 77 78 78 78 79 79 79 79 80 80 80 81 81 81 81 82 82 82 83 83 83 83 84 84 84 85 85 85 86
72 72 73 73 73 73 74 74 74 75 75 75 75 76 76 76 76 77 77 77 78 78 78 78 79 79 79 80 80 80 80 81 81 81 82 82 82 82 83 83 83 83 84 84 84 85 85 85 85 86 86
73 73 74 74 74 74 75 75 75 75 76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 81 81 81 81 82 82 82 82 83 83 83 84 84 84 84 85 85 85 85 86 86 86 87
74 74 75 75 75 75 76 76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 81 81 81 81 82 82 82 82 83 83 83 83 84 84 84 84 85 85 85 85 86 86 86 86 87 87
75 75 76 76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 80 81 81 81 81 82 82 82 82 83 83 83 83 84 84 84 84 85 85 85 85 86 86 86 86 87 87 87 87 88
76 76 76 77 77 77 77 78 78 78 78 79 79 79 79 80 80 80 80 81 81 81 81 82 82 82 82 82 83 83 83 83 84 84 84 84 85 85 85 85 86 86 86 86 87 87 87 87 88 88 88
77 77 77 78 78 78 78 79 79 79 79 80 80 80 80 80 81 81 81 81 82 82 82 82 83 83 83 83 83 84 84 84 84 85 85 85 85 86 86 86 86 86 87 87 87 87 88 88 88 88 89
78 78 78 79 79 79 79 80 80 80 80 80 81 81 81 81 82 82 82 82 82 83 83 83 83 84 84 84 84 84 85 85 85 85 85 86 86 86 86 87 87 87 87 87 88 88 88 88 89 89 89
79 79 79 80 80 80 80 80 81 81 81 81 82 82 82 82 82 83 83 83 83 83 84 84 84 84 84 85 85 85 85 86 86 86 86 86 87 87 87 87 87 88 88 88 88 88 89 89 89 89 90
80 80 80 81 81 81 81 81 82 82 82 82 82 83 83 83 83 83 84 84 84 84 84 85 85 85 85 85 86 86 86 86 86 87 87 87 87 87 88 88 88 88 88 89 89 89 89 89 90 90 90
81 81 81 82 82 82 82 82 83 83 83 83 83 83 84 84 84 84 84 85 85 85 85 85 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 89 89 89 89 89 90 90 90 90 90 91
82 82 82 83 83 83 83 83 83 84 84 84 84 84 85 85 85 85 85 85 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 88 89 89 89 89 89 90 90 90 90 90 90 91 91 91
83 83 83 84 84 84 84 84 84 85 85 85 85 85 85 86 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 88 89 89 89 89 89 89 90 90 90 90 90 90 91 91 91 91 91 92
84 84 84 84 85 85 85 85 85 85 86 86 86 86 86 86 87 87 87 87 87 87 88 88 88 88 88 88 88 89 89 89 89 89 89 90 90 90 90 90 90 91 91 91 91 91 91 92 92 92 92
85 85 85 85 86 86 86 86 86 86 87 87 87 87 87 87 87 88 88 88 88 88 88 88 89 89 89 89 89 89 90 90 90 90 90 90 90 91 91 91 91 91 91 91 92 92 92 92 92 92 93
86 86 86 86 87 87 87 87 87 87 87 88 88 88 88 88 88 88 89 89 89 89 89 89 89 90 90 90 90 90 90 90 90 91 91 91 91 91 91 91 92 92 92 92 92 92 92 93 93 93 93
87 87 87 87 88 88 88 88 88 88 88 88 89 89 89 89 89 89 89 89 90 90 90 90 90 90 90 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 94
88 88 88 88 88 89 89 89 89 89 89 89 89 90 90 90 90 90 90 90 90 91 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 94 94 94 94 94
89 89 89 89 89 90 90 90 90 90 90 90 90 90 91 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 95
90 90 90 90 90 91 91 91 91 91 91 91 91 91 91 92 92 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95
91 91 91 91 91 91 92 92 92 92 92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 96
92 92 92 92 92 92 92 93 93 93 93 93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96
93 93 93 93 93 93 93 93 94 94 94 94 94 94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 96 96 96 96 96 97
94 94 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97
95 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98
96 96 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98
97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99
98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99
99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50
51 76
52 76 77
53 77 77 78
54 77 78 78 79
55 78 78 79 79 80
56 78 79 79 80 80 81
57 79 79 80 80 81 81 82
58 79 80 80 81 81 82 82 82
59 80 80 81 81 82 82 82 83 83
60 80 81 81 82 82 82 83 83 84 84
61 81 81 82 82 82 83 83 84 84 84 85
62 81 82 82 83 83 83 84 84 84 85 85 86
63 82 82 83 83 83 84 84 84 85 85 86 86 86
64 82 83 83 83 84 84 85 85 85 86 86 86 87 87
65 83 83 84 84 84 85 85 85 86 86 86 87 87 87 88
66 83 84 84 84 85 85 85 86 86 86 87 87 87 88 88 88
67 84 84 84 85 85 85 86 86 86 87 87 87 88 88 88 89 89
68 84 85 85 85 86 86 86 87 87 87 88 88 88 88 89 89 89 90
69 85 85 85 86 86 86 87 87 87 88 88 88 89 89 89 89 90 90 90
70 85 86 86 86 87 87 87 87 88 88 88 89 89 89 90 90 90 90 91 91
71 86 86 86 87 87 87 88 88 88 88 89 89 89 90 90 90 90 91 91 91 92
72 86 87 87 87 87 88 88 88 89 89 89 89 90 90 90 90 91 91 91 92 92 92
73 87 87 87 88 88 88 88 89 89 89 89 90 90 90 91 91 91 91 92 92 92 92 93
74 87 88 88 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93
75 88 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93 93 94 94
76 88 88 89 89 89 89 90 90 90 90 91 91 91 91 92 92 92 92 93 93 93 93 94 94 94 94
77 89 89 89 89 90 90 90 90 91 91 91 91 91 92 92 92 92 93 93 93 93 94 94 94 94 94 95
78 89 89 90 90 90 90 91 91 91 91 91 92 92 92 92 93 93 93 93 93 94 94 94 94 95 95 95 95
79 90 90 90 90 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 95 95 95 95 95 96
80 90 90 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 95 95 95 95 95 96 96 96
81 91 91 91 91 91 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 96 96 96 96 96
82 91 91 92 92 92 92 92 92 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 96 96 96 96 96 96 97 97
83 92 92 92 92 92 93 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 97 97 97 97
84 92 92 92 93 93 93 93 93 93 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97
85 93 93 93 93 93 93 94 94 94 94 94 94 94 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97 97 98 98
86 93 93 93 94 94 94 94 94 94 94 95 95 95 95 95 95 95 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 98 98 98 98
87 94 94 94 94 94 94 94 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 98 98 98 98 98 98 98
88 94 94 94 94 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 99
89 95 95 95 95 95 95 95 95 95 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 99 99 99
90 95 95 95 95 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99
91 96 96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99
92 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99
93 97 97 97 97 97 97 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100
94 97 97 97 97 97 97 97 97 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100
95 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100
96 98 98 98 98 98 98 98 98 98 98 98 98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100
97 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100 100 100 100 100 100
98 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 99 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
99 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100
51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100
267
PART 2
DIVISION 2—NON-ECONOMIC LOSS
INTRODUCTION Table 1: pain and suffering
The degree of non-economic loss is to be assessed in Only permanent pain and suffering is considered. Suffering is
accordance with this part. the mental distress as a result of the accepted conditions (it
includes emotional symptoms such as grief, anguish, fear,
The compensation payable for non-economic loss is divided into
frustration, humiliation, embarrassment etc).
two equal amounts. The formula to calculate the total payable in
an individual case is: This table does not include temporary pain and suffering. Nor
does it include speculation of future pain and suffering that has
$ Total = A + B
not yet manifested itself.
WHERE A = the percentage assessment of total permanent
A score out of five is assessed for both pain and for suffering.
impairment, multiplied by the first half of the maximum
These two scores are then combined with the scores derived
AND B = a reasonable percentage of the second half of the from Tables 2, 3 and 4 using the combined value calculation
maximum, having regard to the non-economic loss suffered. (Table 5).
To calculate B, the following tables in this part are used: Pain
Table 1: Pain and suffering Score Description of level of effect

0 No pain experienced.
Table 2: Loss of amenities
Intermittent attacks of pain of nuisance value only.
Can be ignored when activity commences.
Table 4: Loss of expectation of life Intermittent attacks of pain. Not easily tolerated, but
2
short lived. Responding fairly readily to treatment.
Table 5: Combined value calculation
Episodes of pain more persistent. Not easily
3
Table 6: Final calculation. tolerated. Treatment, if available, of limited benefit.
Pain occurring most of the time. Restrictions on
4
activity. Resistant to treatment.
Pain continuous and severe preventing activity. Not
5
controlled by medication.
268
MOBILITY
Suffering
Score Description of effect Concerns the employee’s ability to move around in his or her
environment.
0 No symptoms experienced.
Symptoms minimal or ill defined. Occur Score Description of effect
1
intermittently. No interference with activity.
0 No or minimal restrictions on mobility.
Distinct symptoms. Episodic in nature. Activities
Effects on mobility periodic or intermittent—in
2 reduced during such episodes. Recovers quickly
between episodes no restrictions. Effects continuing
after episodes. 1
but mild (eg slowing of pace, need for a walking
Symptoms distinct and varied. Episodes occur stick) (can do everything, but at a slower pace).
regularly. Ability to cope or perform activity
3 Mobility reduced, but remains independent of others
effectively reduced during episodes. Needs time to
both within and outside the home. Can travel but
recover between episodes. Treatment of benefit. 2
may need to have rest breaks, special seating or
Symptoms wide ranging. Tend to dominate other special treatment.
thinking. Little time when free of symptoms.
4 Mobility markedly reduced. Needs some assistance
Difficulty coping or performing activity. Treatment 3
from others. Unable to use most forms of transport.
necessary.
Symptoms wide ranging. Tend to dominate
Constantly focussed on condition. Ruled by
thinking. Little time when free of symptoms.
emotions. Symptoms interfere with normal thought
5 Difficulty coping or performing activity. Treatment
processes. Unable to cope. Activities severely
necessary.
restricted. Treatment of no real help.
Restricted to home and vicinity. Can only travel with
4
Table 2: loss of amenities door to door transport. Needs assistance of others.
Severely restricted mobility (eg bed, chair, room).
Loss of amenities is also known as loss of enjoyment of life. 5 Dependent on others for assistance. Mechanical
devices or appliances used (eg wheelchair, hoist).
A score out of five is assessed for each of the following:
> mobility
> social relationships
> recreation and leisure activities.
These are then combined with the scores from Tables 1, 3 and 4
using the combined value calculation (Table 5).
269
SOCIAL RELATIONSHIPS RECREATION AND LEISURE ACTIVITIES
Concerns the employee’s capacity to engage in usual social and Concerns the employee’s ability to maintain customary
personal relationships. recreational and leisure pursuits
Score Description of effect Score Description of effect

0 Usual relationships unaffected. 0 Able to follow usual recreation and leisure activities.
Minor interference with personal relationships, Intermittent interference with activities. In between
1
1 causing some reduction in social activities and episodes able to pursue usual activities.
contacts.
Interference with activities reduces frequency of
Relationships confined to immediate and extended 2 activity, but is able to continue. Is able to enjoy
2 family and close friends, but unable to relate to alternatives.
casual acquaintances.
Unable to continue activity. Alternative less
3
Difficulty in maintaining relationships with close satisfying activity possible.
3
friends and the extended family.
Range of activities greatly reduced. Needs some
4
4 Social contacts confined to immediate family. assistance to participate.
5 Difficulties relating socially to anyone. Unable to undertake any satisfying or rewarding
5
activities.
5 Difficulty relating socially to anyone.
270
Table 3: Other loss Table 4: Loss of expectation of life
This table is used to assess losses of a non-economic nature A score out of three is assessed. This is then combined with
that are not adequately covered by Table 1, 2 or 4. the scores derived from Tables 1, 2 and 3. using the combined
value calculation (Table 5). Loss of expectation of life is
A score out of 3 is assessed. This is then combined with the
restricted to a maximum of three points because of the value
scores derived from Tables 1, 2 and 4. using the combined
placed on it by the courts in damages cases.
value calculation (Table 5).
The factors to be considered include: Score Description of effect
> dependence upon external life saving or supporting machine 0 Loss of life expectancy of less than one year.
(for example, aspirator, respirator, dialysis machine, or any Loss of life expectancy of 1 year to less than 10
1
form of electro-mechanical device for the sustenance or years.
extension of activities) Loss of life expectancy of 10 years to less than 20
2
> dependence upon a specialised diet years.
> detrimental effects of climatic features (for example, 3 Loss of life expectancy of 20 years or more.
temperature, humidity, ultra-violet rays, light, noise, dust)
> move to specially modified premises.
Score Description of effect

0 Nil or minimal disadvantages
1 Slight disadvantages
2 Moderate disadvantages
3 Marked disadvantages
271
Table 5: Combined value calculation Conversion of total of scores to a percentage
This table converts the total of the scores (assessed in Tables 1, A. If the combined total of scores from Tables 1, 2, 3 and 4
2, 3 and 4) to a percentage of the second half of the maximum equals or is greater than 15, then 100 percent of the second half
lump sum payable for non-economic loss. of the maximum is payable
or
Calculation of total of scores
B. If the combined total of scores from Tables 1, 2, 3 and 4
Table 1: Pain and suffering
is less than 15, then the percentage of the second half of the
(Pain score ____) x 0.5 = ____ maximum that is payable is calculated using the following
formula:
(Suffering score ____) x 0.5 = ____
(total of scores) x 100
15
Table 2: Amenities of life
(Mobility score ____) x 0.6 = ____
Social relationships score ____) x 0.6 = ____
(Recreation and leisure activities score ____) x 0.6 = ____
Table 3: Other loss
(Score ____) x 1.0 = ____
Table 4: Loss of expectation of life
(Score ____) x 1.0 = ____
Total of scores = ____

272
Table 6: Final calculation
(benefit levels as from 1 July 2011)*
(1) Whole person impairment

(as per Permanent impairment questionnaire) ______ % x $163,535.42 $__________
(2) First half of $30,662.91 ______ % x $30,662.91 $__________
(3) Second half of $30,662.91

(as per non-economic loss questionnaire)
Table 1: Pain and suffering

Pain score ______
Suffering score ______
Subtotal of scores ______ x 0.5 = ______
Table 2: Amenities of life

Mobility score ______
Social relationships score ______
Recreation and leisure Activities score ______
Subtotal of scores ______ x 0.6 = ______
Table 3: Other loss

Other loss score ______ x 1.0 = ______
Table 4: Loss of expectation of life

Loss of expectation score ______ x 1.0 = ______
273
Total of scores
If Score > 15: pay maximum $30,662.91

If Score < 15: calculate % of $30,662.91
using following formula:
(total of scores) $__________

x 100
15
Total $__________
*These are indexed annually on 1 July in accordance with CPI. Check with Comcare for the latest rates if unsure.
274
SCHEDULE OF AMENDMENTS IN EDITION 2.1 OF THE GUIDE
ERRATA FROM COMCARE GUIDE EDITION 2.0
Edition 2.1
Amendment Reason
Page No.
To accommodate update to
ALL Reference to ‘Second Edition, 2005’ replaced with ‘Edition 2.1, 2011’
Edition 2.1
Compliance with Federal
ALL Reference to ‘current guide’ replaced with ‘5th edition 2001’ Court decision in Comcare v
Broadhurst
Introduction to Edition 2.1 of the guide
2. Structure of this guide
At paragraph 3, insertion of ‘The responsibility for development of any guide Editorial change highlighting
that applies to members of the Defence Force in respect of injuries incurred after the need to apply Part 2 for
ix
the commencement of the Military Rehabilitation and Compensation Act 2004 Australian Defence Force
(MRC Act) will fall to the Military Rehabilitation and Compensation Commission members
(MRCC).’
3. Application of this guide
At paragraph 3, insertion of ‘This edition varies the second edition by addressing Insertion to remove ambiguity
medical ambiguities identified by medical practitioners using the second edition
of the Guide, addressing various errata and providing a 10% impairment rating
for all tables within the guide.’
x At paragraph 6, insertion of ‘Where a request by an employee pursuant to Insertion to remove ambiguity
subsection 25(1) of the SRC Act (in respect of interim payment of permanent
impairment compensation) is received by the relevant authority on or after 1
December 2011, but relates to a claim under section 24 of the SRC Act that
was received by the relevant authority on or after 1 March 2006 but before 1
December 2011, that request must be determined under the provisions of the
second edition of the guide.’
4. Whole person impairment (WPI)
At paragraph 2, insertion of ‘This guide, like the previous editions, is, for the
xi purposes of expressing the degree of impairment as a percentage, based on the Insertion to remove ambiguity
concept of ‘whole person impairment’. Subsection 24(5) of the SRC Act provides
for the determination of the degree of permanent impairment of the employee
resulting from an injury, that is, the employee as a whole person.’
275
Edition 2.1
Amendment Reason
Page No.
9. Increase in the degree of whole person impairment To accommodate for Comcare
xiv
At paragraph 1, insertion of ‘in respect of the same injury’ v Canute.
PART 1— Claims for permanent impairment other than defence related claims
Principle of assessment 7: percentages of impairment
At paragraph 1, ‘Each table’ replaced with ‘Most tables’ Errata
At paragraph 1, ‘Contains’ replaced with ‘provide’
At paragraph 1, insertion of ‘fixed’ and ‘such’
At paragraph 2, insertion of ‘Where a table provides for impairment values Insertion to remove ambiguity
within a range, consideration will need to be given to all criteria applicable to the
condition, which includes performing activities of daily living and an estimate
12 of the degree to which the medical impairment interferes with these activities. In
some cases, additional information may be required to determine where to place
an individual within the range. The person conducting the assessment must
provide written reason why he or she considers the selected point within the
range as clinically justifiable.’
At paragraph 3, insertion of ‘For further information relating to the application of Insertion to remove ambiguity
this guide, please contact the Comcare Permanent Impairment Guide Helpdesk
on 1300 366 979 or email PI.Guide@comcare.gov.au .’
276
Edition 2.1
Amendment Reason
Page No.
Principle of assessment 9: combined values To accommodate for Comcare
At paragraph 2, insertion of ‘Where there is an initial injury (or pre-existing v Canute
condition) which results in impairment, and a second injury which results
in impairment to the same bodily part, system or function the pre-existing
impairment must be disregarded when assessing the degree of impairment of
the second injury. The second injury should be assessed by reference to the
functional capacities of a normal healthy person. The final scores are then added
together.’
At paragraph 2, deletion of ‘Where two or more injuries give rise to the same To accommodate for Comcare
whole person impairment only a single rating should be given. For example, v Canute
12 impairments resulting from separate injuries to the left and right knees are
initially assessed separately under Table 9.3 and then, in accordance with the
notes at Part 1 – Introduction to Chapter 9 on page 74, the impairments are
combined using the Combined Values Chart to obtain the overall impairment
for the lower extremity function which is taken to be a single whole person
impairment. Alternatively, a whole person impairment value can be obtained
using the method set out in Table 9.7 (which treats the injuries to both knees as
the same impairment*) and this value can then be compared to the combined
value previously obtained to determine which is the most beneficial. [*The notes
on page 84 to Table 9.7 provide: ‘A single assessment may only be made under
Table 9.7, irrespective of whether one or two extremities are affected by the
injury’].’
Glossary
14 At definition of whole person impairment, insertion of ‘(or WPI) is the Insertion to remove ambiguity
methodology used for expressing the degree of impairment of a person, resulting
from an injury, as a percentage.’
1.2 Hypertension Replacement to remove
22
At paragraph 1, ‘highest’ replaced with ‘higher’ ambiguity
1.4 Peripheral vascular disease of the lower extremities

25 Errata
At paragraph 1, ‘Amputations’ replaced with ‘Amputees’
277
Edition 2.1
Amendment Reason
Page No.
Table 1.4: Peripheral vascular disease of the lower extremities
25 Insertion to remove ambiguity
At 0% WPI, insertion of ’ischaemic’
1.5 Peripheral vascular disease of the upper extremities
26 Errata
At paragraph 1, ‘Amputations’ replaced with ‘Amputees’
2.0 Introduction
At paragraph 3, insertion of ‘of similar individuals’
2.1 Assessing impairment of respiratory function
29 Errata
In above heading, ‘to’ replaced with ‘of’
2.1.1 Measurements
At paragraph 5, insertion of ‘rating’
2.1.2 Methods of measurement
At paragraph 2, deletion of ‘source of each’
30 Errata
At paragraph 2, ‘method’ replaced with ‘method(s)’
At paragraph 2, insertion of ‘used’
2.1.3 Impairment rating
At paragraph 2, ‘is’ replaced with ’are’
2.2 Asthma and other hyper-reactive airways diseases
At paragraph 1, insertion of ‘Assessment of’
At paragraph 2, ‘initiated’ replaced with ‘provoking’
31 At paragraph 3, ‘ed’ replaced with ‘edition’ Errata
At paragraph 3, insertion of ‘by the medical profession’
At paragraph 4, insertion of ‘to provoking factors’
At paragraph 4, ‘improve’ replaced with ‘decrease’
278
Edition 2.1
Amendment Reason
Page No.
2.4 Breathing disorders associated with sleep
34 At paragraph 4, deletion of ‘or stroke’ Errata
At paragraph 4, ‘against’ replaced with ‘using’
Notes to Figure 2-B
35 Errata
Insertion of ‘#’ symbol in ‘#SaO2’
3.1 Thyroid and parathyroid glands
38 Errata
At paragraph 2, insertion of ‘stabilisation of the condition with’
Table 3.2 Adrenal cortex and medulla
At 0% WPI, deletion of ‘the duration of’
39 Errata
At 15% WPI, ‘with’ replaced with ‘by’
At 70% WPI, ‘with’ replaced with ‘by’
3.3 Pancreas (diabetes mellitus)
40 Errata
At paragraph 4, ‘taken’ replaced with ‘collected’
Table 3.4: Gonads and mammary glands
42 Errata
At 0% WPI, insertion of ‘level of’
Table 4.1: Skin disorders
45 At 10%, 15% and 20% WPI, ‘to 3’ replaced with ‘or more’ Errata
At 25% WPI, ‘to 5’ replaced with ‘or more’
Table 4.2: Facial disfigurement Replacement to remove
47
At 5% and 10% WPI, ‘pinna’ replaced with ‘external ear’ ambiguity
Table 4.3: Bodily disfigurement Replacement to remove

48
At 10% and 20% WPI, ‘outline’ replaced with ‘silhouette’ ambiguity
279
Edition 2.1
Amendment Reason
Page No.
5.0 Introduction
50 At paragraph 2, insertion of ‘The examples provided below are not exhaustive Insertion to remove ambiguity
and should not be seen as a substitute for assessor discretion when making
decisions about impairment ratings.’
At 0%, 5%, 10%, 15%, 20% and 25% WPI, ‘stressors’ replaced with
‘stresses’
51-52 At 30% and 40% WPI, ‘remission’ replaced with ‘readmission’ at bullet point 1 Errata
At 30% and 40% WPI, ‘causing’ replaced with ‘resulting in potential for’ at
bullet point 2
At 90% WPI, deletion of ‘aspects of’
Notes to Table 5.1
At note 6, insertion of ‘qualifications’
At note 6, insertion of ‘Such persons include medical practitioners, nursing staff
and clinical psychologists’
6.0 Introduction
55 Errata
At paragraph 5, ‘causing’ replaced with ‘involving’ at point 6.5
Figure 6-A: Steps for calculating impairment of the visual system Replacement to remove
56
At Step 7, ‘exists’ replaced with ‘is present’ ambiguity
6.1 Central visual acuity

Replacement to remove
58 At paragraph 3, ‘their’ replaced with ‘his / her’
ambiguity
At paragraph 3, ‘if they are’ replaced with ‘provided their correction is’
6.2 Determining loss of monocular visual fields
At paragraph 2, ‘examinations’ replaced with ‘assessments’
61 At paragraph 2, ‘their glasses’ replaced with ‘spectacles’
ambiguity
At paragraph 2, ‘double vision’ replaced with ‘diplopia’
At paragraph 3, ‘extent’ replaced with ‘part’
280
Edition 2.1
Amendment Reason
Page No.
6.3 Abnormal ocular motility and binocular diplopia Replacement to remove
62
At paragraph 2, ‘double vision’ replaced with ‘diplopia’ ambiguity
6.5 Other conditions involving permanent deformities causing up to 10%

impairment of the whole person Replacement ro remove
63
ambiguity
In the above heading, ‘causing’ replaced with ‘involving’
6.6 Calculation of visual system impairment for both eyes
63 Errata
At paragraph 5, ‘column’ replaced with ‘row’
7.0 Introduction
68 Errata
At paragraph 2, ‘Meniere’s’ replaced with ‘Menière’s’
Table 7.4: Speech
At 15% WPI, ‘speaks’ replaced with ‘speaking’ Replacement to remove
70
At 20% WPI, ‘over the’ replaced with ‘by’ ambiguity
At 30% WPI, ‘Virtually inaudible’ replaced with ‘Inaudible’
74 Errata
At paragraph 2, ‘most’ replaced with ‘more’
Table 8.1: Upper digestive tract—oesophagus, stomach, duodenum, small
intestine and pancreas
At 0%, 10%, 20%, 30%, 40%, 50%, 60% and 70%, ‘anatomic’ replaced
with ‘anatomical’
76 At 0%, 10%, 20%, 30%, 40%, 50%, 60% and 70%, ‘pathologic’ replaced Errata
with ‘pathological’
At 10%, 20%, 30%, 40%, 50%, 60% and 70%, ‘restrictions’ replaced with
‘modifications’
At 40% WPI, ‘Any one of the following’ replaced with ‘Any two of the following’
281
Edition 2.1
Amendment Reason
Page No.
Notes to Table 8.1
At note 1, ‘H2’ replaced with ‘H2’ ;
77 Errata
At note 1, ‘supplement’ replaced with ‘supplementation’
At note 3, ‘Restrictive’ replaced with ‘Modified’
Table 8.2: Lower gastrointestinal tract—colon and rectum
At 0%, 10%, 20%, 30%, 40% and 50% WPI, ‘to’ replaced with ‘of’ at
secondary criteria
At 0%, 10%, 20%, 30%, 40%, 50%, 60% and 70% WPI, ‘Restrictive’
replaced with ‘Modified’ at secondary criteria
At 0%, 10%, 20% and 30% WPI, ‘level’ replaced with ‘levels’ at secondary
criteria
78-80 Errata
At 20%, 30%, 40%, 50%, 60% and 70%, ‘anatomic’ replaced with
‘anatomical’ at primary criteria
At 40%, 50%, 60% and 70% WPI, ‘Requirement for’ replaced with ‘Presence’
at secondary criteria
At 60% WPI, insertion of ‘Limitations of Activities of Daily Living’ at secondary
criteria
At 70% WPI, deletion of ‘all’ at secondary criteria
Notes to Table 8.2
80 Errata
At note 2, ‘Restrictive’ replaced with ‘Modified’
282
Edition 2.1
Amendment Reason
Page No.
Table 8.3: Lower gastrointestinal tract—anus
At 0%, 10%, 20%, 30% and 40% WPI, ‘anatomic’ replaced with ‘anatomical’
at primary criteria
At 0% WPI, ‘present’ replaced with ‘absent’ at primary criteria
At 0% WPI, insertion of ‘no’ at primary criteria
At 0% WPI, ‘gas’ replaced with ‘flatus’ at secondary criteria
At 10% WPI, ‘gas’ replaced with ‘flatus’ at secondary criteria
81 At 10% WPI, insertion of ‘Mild incontinence of liquid stool’ at secondary criteria Errata
At 20% WPI, ‘and’ replaced with ‘or’ at secondary criteria
At 20%, 30% and 40% WPI, ‘Moderate faecal incontinence requiring daily
treatment’ replaced with ‘Moderate daily faecal incontinence requiring treatment’
at secondary criteria
At 20%, 30% and 40% WPI, ‘Complete faecal incontinence despite treatment’
replaced with ‘Total faecal incontinence despite treatment’ at secondary criteria
At 40% WPI, ‘or’ replaced with ‘and’ at primary criteria
At 40% WPI, ‘and’ replaced with ‘or’ at secondary criteria
Table 8.5: Chronic hepatitis and parenchymal liver disease
At 0%, 10-15%, 30%, 40%, 50%, 65% and 75% WPI, ‘histologic’ replaced
83-84 with ‘histological’ at primary criteria Errata
At 0%, 10-15%, 30%, 40%, 50%, 65% and 75% WPI, ‘Good’ replaced with
‘Adequate’ at secondary criteria
Notes to Table 8.5
84 Format change for emphasis
Note 5 bolded
283
Edition 2.1
Amendment Reason
Page No.
Table 8.7 Hernias of the abdominal wall
At 5% WPI, the sentence ‘Palapable abdominal wall defect with slight
protrusion, with increased abdominal pressure and readily reducible’ replaced
with ‘Abdominal wall defect with slight protrusion of abdominal contents
palpable with increased abdominal pressure, readily reducible’
At 10% WPI, the sentence ‘Palpable abdominal wall defect with frequent or
persistent protrusion, with increased abdominal pressure, manually reducible’
86 replaced with ‘Palpable abdominal wall defect with frequent or persistent Errata
protrusion of abdominal contents with increased abdominal pressure, manually
reducible’
At 25% WPI, the sentence ‘Palpable abdominal wall defect with persistent,
irreducible or irreparable protrusion at the site of defect, limitation to activities
of daily living’ replaced with ‘Palpable abdominal wall defect with persistent,
irreducible or irreparable protrusion of abdominal contents at the site of defect,
causing limitation of activities of daily living’
Part 1:The lower extremities—Feet and toes, ankles, knees and hips
At paragraph 2, insertion of ‘Where an arthroplasty procedure has been Errata
undertaken, refer to the American Medical Association’s Guides to the Evaluation
of Permanent Impairment 5th edition 2001. Combine the total WPI rating for
abnormal motion with the relevant WPI rating for arthroplasty, obtained from the
American Medical Association’s Guide.’
At paragraph 6, ‘feels’ replaced with ‘considers’
91
At paragraph 6, insertion of ‘Table 9.7 cannot be used if the condition causes Insertion to remove ambiguity
a reduction in the range of motion of a joint and an assessment can be made
under any one or more of Table 9.1, 9.2, 9.3 or 9.4.’
At paragraph 10, insertion of ‘Complex Regional Pain Syndrome in the lower To emphasise the Guide’s
extremities should be assessed using the same methodology as for the Upper intent in respect to Table 9.7
Extremity (see page 111) substituting lower extremity table where appropriate. following the Irwin v Border
The diagnostic requirements of Figure 9-E apply.’ Express AAT decision.
Steps in calculating lower extremity impairment
92 Errata
At step 4, ‘knees’ and ‘hips’ replaced with ‘knee and hip’
284
Edition 2.1
Amendment Reason
Page No.
Table 9.1: Feet and toes
At 0% WPI, ‘and’ replaced with ‘or’ at first sentence
At 1% WPI, ‘and’ replaced with ‘or’ at bullet points 1 and 2
At 2% WPI , ‘and’ replaced with ‘or’ at second sentence and
93-94 Errata
bullet points 1, 2 and 4
At 5% WPI, ‘and’ replaced with ‘or’ at bullet points 2 and 3
At 6% WPI , ‘and’ replaced with ‘or’ at bullet point 1
At 7% WPI, ‘and’ replaced with ‘or’ at bullet point 1
Table 9.3: Knees
At 14% WPI, ‘8-12’ replaced with ‘more than 12’ at bullet point 1 Replacement to remove
98
At 14% WPI, ‘16-20’ replaced with ‘more than 20’ at bullet point 2 ambiguity
At 20% WPI, ‘over’ replaced with ‘of more than’ at bullet points 1 and 2
Table 9.4: Hips
At 2% WPI, ‘of’ replaced with ‘restricted to’ for internal and external rotation
At 5% WPI, ‘or’ replaced with ‘to’ at bullet point 1
At 5% WPI, insertion of ‘at least’ at bullet point 2
99-100 Errata
At 10% WPI, ‘greater’ replaced with ‘more’ for flexion contracture
At 10% WPI, ‘or’ replaced with ‘to’ at bullet point 1
At 15% WPI, ‘greater’ replaced with ‘more’ for abduction contracture
At 15% WPI, ‘or’ replaced with ‘at least’ at bullet points 2, 3 and 5
Table 9.5: Lower extremity amputations
At 1% WPI ‘and’ replaced with ‘or’
At 2% WPI, ‘and’ replaced with ‘or’ at bullet point 3
101-102 At 32% WPI, deletion of ‘through’ and ‘portion of’ Errata
At 32% WPI, ‘thigh’ replaced with ‘midthigh’
At 40% WPI, deletion of ‘through’
At 40% WPI, ‘thigh’ replaced with ‘midthigh’
285
Edition 2.1
Amendment Reason
Page No.
9.7 Lower extremity function
At paragraph 5, ‘irrespective’ replaced with ‘regardless’
106-107 At paragraph 6, insertion of ‘In particular, Table 9.7 cannot be used where Errata
the condition causes a reduction in the range of motion of a joint and an
assessment can be made under any one or more of Table 9.1, 9.2, 9.3 or 9.4.’
Table 9.7: Lower extremity function
At 5%, 10%, 20% and 30% WPI, ‘resulting in’ replaced by ‘causing’ at minor
criteria To emphasise the Guide’s
At 5%, 10%, 20% and 30% WPI, deletion of ‘at a time’ at major criteria intent in respect to Table 9.7
108-109
following the Irwin v Border
At 20% WPI, insertion of ‘a walking aid or hand’ Express AAT decision.
At 30% WPI, ‘someone else’ replaced with ‘another person’ at minor criteria
At 40% and 50% WPI, deletion of ‘at a time’ at major criteria
Part II: The Upper Extremities: Hands and Fingers, Wrists, Elbows and Shoulders
To emphasise the Guide’s
At paragraph 4, ‘feels’ replaced with ‘considers’
intent in respect to Table 9.7
110 At paragraph 4, insertion of ‘Table 9.14 cannot be used unless the condition following the Irwin v Border
involves radiographically demonstrated joint instability or arthritis or the Express AAT decision.
employee has had an arthroplasty.’
9.8.1 Abnormal motion of digits
111 Errata
At paragraph 2, ‘from’ replaced with ‘for’
286
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Table 9.8.1b: Radial abduction/adduction/opposition of the thumb—abnormal
motion/ankylosis
At 0% WPI, ‘abduction’ replaced with ‘adduction’ for loss of less than 10%
At 0% WPI, ‘adduction’ replaced with ‘abduction’ for loss less than 35%
At 0% WPI, ‘greater’ replaced with ‘more’
113-114 Errata
At 1% WPI, ‘abduction’ replaced with ‘adduction’ for loss of less than 10-20%
At 1% WPI, ‘adduction’ replaced with ‘abduction’ for loss less than 35-40%
At 1% WPI, ‘or’ replaced with ‘to’ for ankylosis
At 2% WPI, ‘abduction’ replaced with ‘adduction’ for loss of 25% or more
At 2% WPI, ‘adduction’ replaced with ‘abduction’ for loss of 45% or more
9.8.2 Sensory losses in the thumb and fingers
At paragraph 6, deletion of ‘particular’
118 Errata
At paragraph 9, ‘this is reserved’ replaced with ‘losses involving the radial digital
nerve are rated higher than those of the ulnar digital nerve’
9.9 Wrists Replacement to remove
121
At paragraph 2, ‘range’ replaced with ‘plane’ ambiguity
9.10 Elbows Replacement to remove

124
9.11 Shoulders Replacement to remove

127
9.13.3 Complex regional pain syndromes Replacement to remove

142
At paragraph 6, ‘one’ replaced with ‘a rating’ ambiguity
Figure 9-F: Impairment grading for CRPS

143 Errata
Deletion of CRPS II table
287
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Steps in CRPS I (RSD) impairment determination
Table replaced with:
Step 1 Assess the WPI for the affected upper extremity resulting from the
loss of motion of each affected joint using Tables 9.8 to 9.11 as
appropriate.
Step 2 Assess the appropriate percentage impairment of the affected
extremity resulting from sensory deficits and pain of the injured
nerve(s) according to the grade that best describes the severity of
interference with activities as described in Figure 9-D. Use clinical
judgment to select the appropriate severity grade from Figure 9-D
and determine the WPI % for the relevant nerve(s) from Table
9.13.2a.. Replacement to provide
144 The maximum value is not automatically applied. greater clarity and consistency
with AMA5
Step 3 Assess the appropriate percentage impairment of the affected
extremity resulting from motor deficits and loss of power of the
injured nerve(s) according to the grade that best describes the
severity of interference with as described in Figure 9-D. Use
clinical judgment to select the appropriate severity grade from
Figure 9-D determine the WPI% for the relevant nerve(s) from
Table 9.13.2b.
Step 4 Combine the impairment ratings for sensory deficits and pain
(Step 2), and for motor deficits and loss of power (Step 3),
with the rating obtained from Step 1. The maximum WPI for the
affected extremity is 60%.
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9.14 Upper extremity function
At paragraph 1, insertion of ‘In particular, Table 9.14 cannot be used where an To emphasise the Guide’s
assessment can be made under one or more Table 9.9, 9.10 or 9.11 and there intent in respect to Table 9.7
is no radiologically demonstrated joint instability or arthritis or arthroplasty.’ following the Irwin v Border
At paragraph 6, ‘can’ replaced with ‘cannot’ Express AAT decision.
At paragraph 7, insertion of ‘assessment of’ Errata
145
At paragraph 8, insertion of ‘(see Appendix 1)’
At paragraph 8, ‘chosen’ replaced with ‘used to determine WPI’
At paragraph 9, ‘chosen’ replaced with ‘used to determine WPI’
At paragraph 10, ‘Observe’ replaced with ‘Use’
At paragraph 10, deletion of ‘However’
Table 9.14: Upper extremity function
At 0% and 3% WPI for non-dominant extremity, ‘30’ replaced with ‘13’ at minor
criteria
146 At 0% and 3% WPI for non-dominant extremity, ‘20’ replaced with ‘9’ at minor Errata
criteria
At 10% WPI for non-dominant extremity, ‘10’ replaced with ‘4.5’ at minor criteria
At 15% WPI for non-dominant extremity, ‘3’ replaced with ‘1.5’.at minor criteria
Part III: Definitions of clinical findings for diagnosis-related estimates in assessing
spinal impairment
149-151 At paragraph 6, ‘by reason of’ replaced with ‘through’ Errata
At paragraph 11, insertion of ‘abnormal’
At paragraph 12, deletion of ‘ in a dermatomal distribution’
Part III – Multi-level fractures involving the spinal canal
151 At paragraph 1, insertion of ‘multiple’ Errata
At paragraph 1, ‘and associated’ replaced with ‘with’ at bullet point 3
289
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Table 9.15: Cervical spine—diagnosis-related estimates
At 10-18% WPI, deletion of ‘or’
152-154 Errata
At 28% WPI, insertion of ‘or’
At 38% WPI, insertion of ‘There may be’
Table 9.16: Thoracic spine—diagnosis-related estimates
At 10-18% WPI, insertion of ‘improved’
155 Errata
At 23% WPI, insertion of ‘or’
At 28% WPI, insertion of ‘and’
9.17 Lumbar spine—diagnosis-related estimates
157 Errata
At 23% WPI, ‘Complete,’ replaced with ‘May have complete,’
10.1 The Upper Urinary Tract
At paragraph 2, insertion of ‘rigours’ at bullet point 9
Table 10.1 The upper urinary tract Replacement to remove
161
At 25% WPI, ‘irrespective’ replaced with ‘regardless’ at category B ambiguity
10.3 Lower urinary tract

162 Errata
At paragraph 7, insertion of ‘stranguary’ at bullet point 3
Table 11.1.3: Male reproductive organs – testes, epididymes and spermatic
168 cords Errata
At 0%, 10% and 15% WPI, ‘anatomic’ replaced with ‘anatomical’
Table 11.1.4: Male reproductive organs – prostate and seminal vesicles
169 Errata
At 0% and 10% WPI, ‘anatomic’ replaced with ‘anatomical’
Notes to Table 11.2.2 Replacement to remove
172
At note 2, ‘The contraceptive pill’ replaced with ‘Oral contraception’ ambiguity
290
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12.0 Introduction
At paragraph 2, insertion of ‘impairments’ at bullet point 2
Table 12.1.2: Epilepsy, seizures and convulsive disorders
At 10% and 20% WPI, ‘or’ replaced with ‘and’
178 Errata
At 10% and 20% WPI, insertion of ‘or others’
At 70% WPI, insertion of ‘are’
Figure 12-B: Clinical dementia rating (CDR) Replacement to remove
182
At Community Affairs category, ‘a’ replaced with ‘the employee’s’ ambiguity
Table 12.4: Emotional or behavioural impairments

185 At 10% WPI, ‘useful’ replaced with ‘usual’
ambiguity
At 80% WPI, insertion of ‘any’
Table 12.5.4: The facial nerve (VII) Replacement to remove
188
At 10-12% and 30% WPI, deletion of ‘with’ ambiguity
12.5.5 The auditory nerve (VIII)

189 Errata
At paragraph 5, ‘Meniere’s’ replaced with ‘Menière’s’
12.5.6 The glossopharyngeal, vagus, spinal accessory and hypoglossal nerves
(IX, X, XI and XII) Replacement to remove
190
ambiguity
At paragraph 6, ‘held up’ replaced with ‘delayed’
Table 12.6: Neurological impairment of the respiratory system
192 At 10% WPI, insertion of ‘moderate’ Insertion to remove ambiguity
At 60% WPI, ‘he or she’ replaced with ‘the employee’
Table 13.1: Anaemia Replacement to remove
195
At 20%, 40% and 60% WPI, ‘U’ replaced with ‘Units’ ambiguity
291
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13.2 Leukocyte abnormalities or disease Replacement to remove
195
At paragraph 6, ‘most’ replaced with ‘more’ ambiguity
13.3 Haemorrhagic disorders and platelet disorders Replacement to remove

198
At paragraph 1, ‘with’ replaced with ‘by’ ambiguity
Table 13.3: Haemorrhagic disorders and platelet disorders

At 10% WPI, insertion of ‘is required’
Table B2: Suffering
At 3% WPI, insertion of ‘is’ Replacement to remove
202
At 5% WPI, ‘predominate over thinking’ replaced with ‘interferes with normal ambiguity
thought processes’
Table B3.1: Mobility
Replacement and insertion to
203 At 2% WPI, ‘need to have’ replaced with ‘require rest’
remove ambiguity
At 2% WPI, ‘for example’ replaced with ‘or other special treatment’
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Part 2—Defence-related claims for permanent impairment
Principles of assessment 5: Gradations of impairment
At paragraph 3, insertion of ‘Where a table provides for impairment values
within a range, consideration will need to be given to all criteria applicable to the
condition, which includes performing activities of daily living and an estimate of
219 the degree to which the medical impairment interferes with these activities. In Insertion to remove ambiguity
some cases, additional information may be required to determine where to place
an individual within the range. The person conducting the assessment must
provide written reason why he or she considers the selected point within the
range as clinically justifiable.’
Principle of assessment 6: Combined impairments
At paragraph 1, ‘it is important to realise that impairment’ replaced with
‘Impairment’
At paragraph 1, ‘and that a’ replaced with ‘A’
At paragraph 1, ‘or disease’ replaced with ‘only’
At paragraph 1, ‘only’ replaced with ‘see’ Replacement to remove
219
ambiguity
At paragraph 1, insertion of ‘Where there is an initial injury which results in
impairment, and a second injury which results in impairment to the same bodily
system or function occurs, the pre-existing impairment must be disregarded
when assessing the degree of impairment of the second injury. The second injury
should be assessed by reference to the functional capacities of a normal healthy
person. The final scores are then added together.
Glossary
222 At definition of whole person impairment, insertion of ‘whole person impairment Insertion to remove ambiguity
is the methodology used for expressing the degree of impairment of a person,
resulting from an injury, as a percentage.’
Table 1.2: Peripheral vascular disease
At 0% WPI, insertion of ‘ischaemic’
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Table 1.3: Varicose veins, deep venous thrombosis, oedema, ulceration
At 0% WPI, insertion of ‘of limitation’
At 50% WPI, deletion of ‘Any one of the following which needs continuous Insertion and deletion to
225-226 treatment including long periods of admission to hospital or confinement to remove ambiguity
residence’
At 50% WPI, insertion of ‘which needs continuous treatment including long
periods of admission to hospital or confinement to residence.’
Table 2.1: Ventilatory function Replacement to remove
227
At Notes, ‘best’ replaced with ‘largest’ ambiguity
Table 3.1: Endocrine system

229 At 5% WPI, ‘tablets’ replaced with ‘oral medication’
ambiguity
At 10% WPI, insertion of ‘symptomatic’ at bullet point 4
Table 4.1: Functional Loss
230 At 0% WPI, insertion of ‘other’
At 5% WPI, ‘and’ replaced with ‘but’
Insertion and replacement to
231-232 At 5% WPI, ‘of’ replaced with ‘or’ at bullet point 4
remove ambiguity
At 5% WPI, ‘outer’ replaced with ‘external’ at bullet point 4
At 10% WPI, ‘cheek’, replaced with ‘zygoma’ at bullet point 3
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At 0% WPI, ‘stressors’ replaced with ‘stresses’
At 0% WPI, ‘capable’ replaced with ‘retained capability’
At 5% WPI, ‘stressors’ replaced with ‘stresses’ at bullet point 1
At 5% WPI, ‘community’ replaced with ‘others’ at bullet point 2
At 10% WPI, ‘community’ replaced with ‘others’ at bullet point 2
233-234
At 30% WPI, ‘remission’ replaced with readmission’ at bullet point 1
At 30% WPI, community’ replaced with ‘others’ at bullet point 2
At 40% WPI, ‘More than one’ replaced with ‘both’
At 40% WPI, ‘remission’ replaced with readmission’ at bullet point 1
At 40% WPI, community’ replaced with ‘others’ at bullet point 2
At 90% WPI, deletion of ‘aspects of’
Table 6.1 Disorders of visual acuity
235 At paragraph 1, ‘colour blindness’ replaced with ‘impaired colour vision’ Errata
At paragraph 2, ‘current’ replaced with ‘2nd’.
Table 7.2: Miscellaneous ear, nose and throat disorders
237 Errata
At 60% WPI, ‘but’ replaced with ‘and’
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Table 8.1: Disorders of the oesophagus, stomach, duodenum, small intestine,
pancreas, colon, rectum and anus
At 5% WPI, ‘steady’ replaced with ‘normal’
At 5% WPI, ‘gas’ replaced with ‘flatus’
At 10% WPI, ‘restrictions’ replaced with ‘modification’ at bullet point 1
At 10% WPI, deletion of ‘weight’ at bullet point 3
At 15% WPI, deletion of ‘weight’ at bullet point 3
238-239 At 20% WPI, ‘restrictions’ replaced with ‘modification’ at bullet point 1 Errata
At 20% WPI, insertion of ‘per range on standard BMI chart’ at bullet point 3
At 55-75% WPI, insertion of ‘per range on standard BMI chart’ at bullet point 4
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Table 8.2: Disorders of the liver and biliary tract
At 0% WPI, ‘good’ replaced with ‘adequate’
At 0% WPI, ‘and’ replaced with ‘with’
At 10% WPI, deletion of ‘signs of’
At 10% WPI, insertion of ‘and’
240-241 Errata
At 20% WPI, ‘but’ replaced with ‘and’
At 20% WPI, insertion of ‘now’
Table 8.3: Fistulae and herniae
242 Errata
At 20% WPI, ‘rectus’ replaced with ‘recti’ at bullet point 1
Table 9.1: Upper extemity
At 5% WPI, ‘fingers four and/or five’ replaced with ‘ring and/or small finger’ at
244 bullet point 2 Errata
At 10% WPI, ‘two and/or three’ replaced with ‘index and/or middle’ at bullet
point 3
Table 9.2: Lower extremity
At paragraph 4, ‘assessment’ replaced with ‘assessor’
245 At paragraph 5, ‘Table 9.14’ replaced with ‘Appendix 1’ Errata
At 0% WPI, deletion of ‘first’
At 10% WPI, deletion of ‘first’ at bullet point 3
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Table 9.3: Amputations and/or total loss of function
At paragraph 1, insertion of ‘Impairment relating to the loss of or injury to a
finger or toe refers not only to amputation or total loss of efficient use of the
whole digit, but also to partial loss of efficient use of a digit.’
At 5% WPI, insertion of ‘any’ at bullet point 3
At 5% WPI, insertion of ‘interphalangeal’ at bullet point 4 Insertion and replacement to
246-247
At 5% WPI, ‘forefinger’ replaced with ‘index, middle, ring or little finger’ at bullet remove ambiguity
point 5
At 5% WPI, ‘great toe’ replaced with ‘hallux’
At 30% WPI, ‘of ‘ replaced with ‘at’ at bullet point 2
At 30% WPI, ‘except’ replaced with ‘but not’ at bullet point 3
At 70% WPI, insertion of ‘amputation’
Table 9.6: Spine
Table 10.1: Upper urinary tract
At 0% WPI, ‘better’ replaced with ‘more’ Insertion or replacement to
250
At 10% WPI, ’solitary’ replaced with ‘single’ remove ambiguity
At 85% WPI, insertion of ‘dialysis’
251 At 0% WPI, ‘intervening’ replaced with ‘interval’
ambiguity
At 10% WPI, ‘more’ replaced with ‘greater’
Table 11.1: Male reproductive system
252-253 At 5% and 15% WPI, ‘anatomic’ replaced with ‘anatomical’
ambiguity
At 20% WPI, ‘epididymal’ replaced with ‘epididymis’
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Table 11.2: Female reproductive system Replacement to remove
254
At 10% and 35% WPI, ‘anatomic’ replaced with ‘anatomical’ ambiguity
Table 11.3: Mammary Glands Replacement to remove

255
At 10% WPI, ‘in’ replaced with ‘of’ at bullet point 1 ambiguity
Cranial nerves
At paragraph 1, deletion of ‘The different cranial nerves are numbered I to XII. Deletion to remove
255 For a description of what they are, refer to a medical text or other reference unnecessary information
source such as Chapter 2 of the American Medical Association Guides to the
Assessment of Permanent Impairment.’
Table 12.1
At 10% and 30% WPI, ‘and resulting in’ replaced with ‘with’ at other criteria
256 Errata
At 20% WPI, insertion of ‘VII’
At 60% WPI, ‘gastronomy’ replaced with ‘gastrostomy’
Communication
At paragraph 1, insertion of ‘employee’s’
Table 12.2: Comprehension Replacement to remove
257
At 20% WPI, ‘Restricted to’ replaced with ‘Understands only’ at reading criteria ambiguity
Table 12.3: Expression

258 Errata
At 25% WPI, ‘family’ replaced with ‘familiar’
Notes to Table 12.3
Deletion of ‘Cognitive function has two components – memory and reasoning
258 ability. These functions are affected where there is neurological damage eg, Errata
from a head injury, cerebro-vascular accident etc. Difficulties with memory
or reasoning ability consequent to some other process eg, psychiatric illness
should not be assessed using these tables. Instead Table 6.1 should be used.’
299
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Table 12.4: Memory
At 0% WPI, insertion of ‘education’
At 25% WPI, ‘nonfamiliar’ replaced with ‘unfamiliar’
At 40% WPI, ‘Signs similar in range to previous category but greater in extent’ Insertion and replacement to
259
replaced with ‘Failure to keep appointments or fulfil other obligations despite use remove ambiguity
of memory aids, to a more pronounced extent.’
At 70% WPI, ‘As in previous category but may be of greater severity’ replaced
with ‘Unable to recall recent events or experiences, to a more pronounced extent.’
Notes to Table 12.4
Insertion of ‘Cognitive function has two components – memory and reasoning
259 ability. These functions are affected where there is neurological damage eg, Errata
from a head injury, cerebro-vascular accident etc. Difficulties with memory
or reasoning ability consequent to some other process eg, psychiatric illness
should not be assessed using these tables. Instead Table 6.1 should be used.’
Table 13.1: Intermittent conditions
At paragraph 1, ‘hemopoietic’ replaced with ‘haemopoietic’
At 0%, 10%, 20%, 30%, 40%, 50%, 60%, 70% and 75-95% WPI, ‘Attacks’
261 Errata
replaced with ‘Episodes’
At 40%, 50%, 60%, 70% and 75-95% WPI, ‘occupy’ replaced with ‘occur’
At 70-95% WPI, ‘necessary at’ replaced with ‘required for assessed’
Notes to Table 13.1
262 Insertion of ‘Assessors should refer to the Principles of Assessment for guidance Insertion to remove ambiguity
on awarding an impairment value within a range.’
Table 13.2: Malignancies
Insertion and deletion to
262 At 10-15% WPI, insertion of ‘moderate’
remove ambiguity
At 65% and 75% WPI, deletion of ‘or hospital’
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14. Combined values chart
263 At paragraph 4, insertion of ‘second highest point, then’ Insertion to remove ambiguity
At paragraph 4, insertion of ‘impairments’
Table 1: Pain
267 At 1% WPI, ‘with’ replaced with ‘when’
ambiguity
At 5% WPI, ‘Uncontrolled’ replaced with ‘Not controlled’
Table 1: Suffering
268 At 5% WPI, ‘predominate over thinking’ replaced with ‘ interfere with normal ambiguity
thought processes’
Mobility
Insertion and replacement to
268 At 2% WPI, insertion of ‘rest’
remove ambiguity
At 2% WPI, ‘etc’ replaced with ‘or other special treatment’
Social relationships Replacement to remove
269
At 5% WPI, ‘Difficulties’ replaced with ‘Difficulty’ ambiguity
Recreation and leisure activities

269 At 2% WPI, ‘to’ replaced with ‘with’
ambiguity
At 3% WPI, ‘rewarding’ replaced with ‘satisfying’
Table 3: Other loss
270 At paragraph 3, ‘The types of factors which would be considered here may ambiguity
include’ replaced with ‘The factors to be considered include’
Table 4: Loss of expectation of life Replacement to remove
270
At 3% WPI, ‘greater’ replaced with ‘more’ ambiguity
301
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Table 6: Final calculation
‘2005’ replaced with ‘2011’. Current statutory rates (1 July
272-273
‘$137,501.12’ replaced with ‘$163,535.42’. 2011)
‘$25,781.48’ replaced with ‘$30,662.91’.
BROADHURST TABLES
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Part 1—Claims for permanent impairment other than defence-related claims
Table 3.1: Thyroid and parathyroid glands Insertion of range to allow for
38
‘15%’ replaced with ‘10-15%’. a 10% impairment rating.
Notes to Table 3.1

Table 8.5: Liver—chronic hepatitis and parenchymal liver disease Insertion of range to allow for
83
‘15%’ replaced with ‘10-15%. a 10% impairment rating.
Notes to Table 8.5

Table 9.14: Upper extremity function Increased to allow for a 10%
146
Under Non-Dominant Extremity, ‘8%’ replaced with ‘10%’. impairment rating.
Table 9.15: Cervical spine—diagnosis-related estimates Insertion of a range to allow

153
‘18%’ replaced with ‘10-18%’. for a 10% impairment rating.
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Notes to Table 9.15
Table 9.16: Thoracic spine—diagnosis-related estimates Insertion of a range to allow
155
Notes to Table 9.16

Table 9.17: Lumbar spine—diagnosis-related estimates Insertion of a range to allow
157
Notes to Table 9.17

Table 11.2.1: Female reproductive organs—vulva and vagina Insertion of a range to allow
170

Table 12.1.1: Permanent disturbances of levels of consciousness and awareness Insertion of a range to allow
178

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12.3:Communication impairments—dysphasia and aphasia
Deletion of section 12.3: Communication.
Insertion of new section ‘12.3: Communication impairments—dysphasia and
aphasia’.
‘Communication involves comprehension, understanding, language, and
effective interaction between and among individuals. Aphasia is a condition
in which language function is defective or absent. It includes a lack of
comprehension with deficits in vision, hearing, and language (both spoken
and written), and also the inability to implement discernible and appropriate
language symbols by voice, action, writing or pantomime. Dysphasia is a
language impairment that is less severe that aphasia (which literally means
“no speech”) but still is associated with a lesion in the dominant parietal
lobe. It presents as a communication problem due to receptive or expressive Whole of section 12.3 of the
dysphasia or a combination of the two. Inability to have a meaningful Guide has been substituted
conversation because no nouns are used is an example of dysphasia. Other for section 13.3e of AMA 5.
183 common errors include errors of grammatical structure, word-finding difficulties, Note: The impairment values
and word substitution. Dysphasia and aphasia are different from dysarthria, in Table 12.3 have been
which is imperfect articulation of speech due to disordered muscle control. derived from the median
Dysphonia is an impairment of sound production that causes difficulty speaking values for the various classes
and understanding. Speech and communication impairments due to non in Table 13-7 (See AMA 5).
neurological primary problems are discussed in Chapter 11— Ear, nose, throat
and related structures.
Dysphasia is the most common diagnosis, since most individuals usually retain
some ability to communicate. An inability to understand language has a poorer
prognosis than an inability to express language. Speech therapy is of little value
in the absence of comprehension; therefore, compensatory techniques may not
be learned when a receptive aphasia or dysphasia exists. Tests for dysphasia
should be conducted after it is established how confused or disoriented the
individual is and which side the of the brain is dominant for speech. Cognition
should also be evaluated after dysphasia mechanisms have been excluded.
Dysphasia is the most common diagnosis, since most individuals usually retain
some ability to communicate. An inability to understand language has a poorer
304
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prognosis than an inability to express language. Speech therapy is of little value
in the absence of comprehension; therefore, compensatory techniques may not
be learned when a receptive aphasia or dysphasia exists. Tests for dysphasia
should be conducted after it is established how confused or disoriented the
individual is and which side the of the brain is dominant for speech. Cognition
should also be evaluated after dysphasia mechanisms have been excluded.
Aphasia and dysphasia test batteries are frequently devised by the clinician
and cover the following simple tasks: (1) listening to spontaneous speech or
responses to simple questions; (2) pointing commands and questions that
can be answered “yes” or “no” to test comprehension; (3) repeating words
and phrases; (4) naming objects that have high-and-low frequency use; (5)
reading comprehension and reading aloud (reading is related to educational
achievement, which must be known before interpreting reading comprehension
and reading aloud results); and (6) writing and spelling. If comprehension
is relatively intact, the aphasia screening battery may be adequate to place
an individual in class 1 or 2. However, individuals with dysphasia may
score poorly on aphasia and dysphasia test batteries while they demonstrate
communicative competency for activities of daily living. This communicative
competency may be measured by means of the communicative abilities in daily
living (CADL), in which non verbal communication is assessed. Table 12.3
describes the criteria for rating impairment due to aphasia or dysphasia.’
Insertion of ‘Table 12.3: Criteria for rating impairment due to aphasia or
dysphasia’
% WPI Criteria
Minimal disturbance in comprehension and production of language
5
symbols of daily living.
Moderate impairment in comprehension and production of language
10
symbols of daily living.
Able to comprehend non verbal communication; production of
32
unintelligible or inappropriate language for daily activities.
Complete inability to communicate or comprehend language
50
symbols.
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Table 12.5.3: The trigeminal nerve (V) Increased to allow for a 10%
187
‘8%’ replaced with ‘10%’. impairment rating.
Table 12.5.4: The facial nerve (VII) Insertion of a range to allow

188

Table 12.7: Neurological impairment of the urinary system Insertion of a range to allow
192
Notes to Table 12.7

PART 2—Defence-related claims for permanent impairment
Table 11.3: Mammary glands Increased to allow for a 10%
255
‘5%’ replaced with ‘10%’. impairment rating.
Table 13.2: Malignancies Insertion of a range to allow

262
Notes to Table 13.2

306
INDEX
A B
activities of daily living 12, 14, 46, 50, 51, 52, 74, 88, 177, biliary colic 85, 240
189, 196, 197, 218, 219, 230, 233, 234, 261 biliary tract 85, 240, 296
defined 14, 17, 74, 176, 196, 221 birth, vaginal delivery 170, 254
acuity, visual, disorders of 235, 294 blindness
aggravation - colour 235, 294
see Principles of Assessment - night 235
ailment
defined 14, 221
amenities, loss of 203, 218, 268
C
defined 14, 203, 222 Cardiovascular System 16–27, 223–6
amputations 25, 26, 101, 102, 133, 134 cervical stenosis 171, 254
anaemia 79, 80, 160, 195, 239, 261 cervix 171, 254
ankle 89, 91, 95–6, 245, 247, 283 cheek, depression of 47
ankylosis claudication 25, 26, 224
- upper extremity 110, 11, 112, 113–16, 118, 121, 122, cognitive function 180, 255, 259, 298, 299
123, 124, 125, 126, 127, 128, 129, 130, 131, 132, colic, biliary 85, 240
244, 286 colon 78–80, 238–9, 281, 295
- lower extremity 91, 92, 93, 94, 97, 98, 99, 100, 245 colostomy 82, 242
anus 81, 238, 282, 295 colour blindness 235, 294
ascites 83, 84, 240 combined value calculation 267, 268, 270, 271
assessment, double combined values chart 209–12
see Principles of Assessment communication, and neurological function 255
assessments, interim comprehension, and neurological function 255, 257–8
see Principles of Assessment conjunctivitis 235
assessments of symptomatic activity levels 223 cranial nerves 186, 255–6, 298
asthma 31–4, 261, 277
307
D epididymal disease 168, 252, 253, 297
epilepsy 178, 261, 290
deep venous thrombosis 225–6, 293 expectation of life, loss of 200, 205, 218, 222, 270, 271,
depression 272, 300
- of the cheek 47, 232 expression, and neurological function 255, 257, 258, 298
- of the frontal bones 232
diabetes mellitus 39, 40–1, 42, 229,
F
diastasis of rectus 242
Digestive System 73–86, 238–42 facial disfigurement 47, 231, 278, 293
diplopia 61, 62, 63, 256, 279, 280 facial paralysis 188, 232
disease fallopian tubes 172, 173, 254
defined 14 female reproductive system 172–3, 254
disfigurement fingers 89–90, 110, 111, 115–16, 117, 118, 119, 133, 134,
220, 246, 247, 285, 286, 296
see facial disfigurement
see also Principles of Assessment
double assessment
fistulae 163, 242, 296
see Principles of Assessment
flail joints 245
duodenum 76–7, 238–9, 280, 295
E G
galactorrhoea 255
ear 47, 188, 232, 278
gastrostomy 72, 82, 242, 256, 298
Ear, Nose and Throat Disorders 67–72, 236–7
glaucoma 235
external ear 47, 232, 278
gynaecomastia 42, 84, 255
elbow 90, 110, 124–5, 244, 247
employability
Endocrine System 37–42, 44, 55, 160, 229, 293
308
H I
haemodialysis 160, 250 ileostomy 82, 242
haemopoietic system 261, 299 impairment
headache, tension 13, 261 defined 10, 14, 218, 221
hearing 13, 17, 46, 50, 68, 74, 88, 177, 183, 188, 196, - gradations of 219, 292
231, 236 - permanent 10, 14, 218
see also hearing and neurological function 257, see Principles of Assessment
258, 303
impairments, combined 107, 219, 292
heart disease
- ischaemic 17, 18, 19, 223
impotence 252, 253
- rheumatic 18, 19, 223
incapacity 10, 218
hemipelvectomy 102, 247
herniae 86, 242, 283, 296
incontinence 81, 162, 163, 182, 192, 238, 251
hepatic coma 241
- faecal 81, 238, 239, 282
hepatic insufficiency 84, 85, 240, 241
inguinal hernia 242
hip 89, 91, 92, 99, 102, 245, 247, 283, 284
injury
hormonal abnormality, male 42, 168, 252, 253
defined 14, 222
hyperparathyroidism 38, 229
interim assessments
hypertension 18, 19, 22–3, 160, 223, 276
intermittent conditions 261, 299
intestine, small 76–7, 238–9, 280, 295
ischaemic heart disease 17, 18, 19, 223
ischaemic pain 25, 224
309
J M
jaundice 83, 84, 85, 240, 241 male reproductive system 165–9, 252–3, 289, 297
jejunostomy 82, 242 malignancies 11, 262, 299, 305
memory 176, 180–1, 259, 298, 299
K Menière’s disease 68, 189, 280, 290

menopause 170–3, 254
kidney 160, 161, 250
metabolic costs of activities, table of 223–4
knee 89, 91, 92, 97–8, 245, 247, 276, 283, 284
migraine 13, 261
mobility, and loss of amenities 14, 200, 203, 206, 222, 268,
L 271, 272, 291, 300
motor loss, paralysis, and cranial nerves 186, 188, 256
leisure activities, and loss of amenities 10, 14, 203, 204, 205,
Musculo-skeletal System 243–9
206, 218, 222, 268, 269, 271, 272, 300
leukocyte N
disease 195–6
nasal discharge, post 237
disorders 261
neuralgia
limb function 243
- facial 256
- upper 248
- trigeminal 187, 256
- lower 248
neurological function 255–60
liver 83–4, 85, 240–1, 282, 296, 301
neuroses 53, 233–4
loss of amenities 10, 200, 203–4, 218, 267, 268
non-economic loss 10, 200–7, 218, 267–73
defined 14, 222
defined 14, 218, 222
loss of expectation of life 10, 14, 200, 205, 206, 218, 222,
267, 270, 271, 272, 300
nose, disfigurement, loss 47, 232
loss, other 200, 205, 206, 267, 270, 271, 272, 300
nystagmus 235
lower urinary tract 162–3, 251, 289, 297
310
O pigmentation, facial 47, 232
personality disorders 53, 233–4
oedema 26, 143, 160, 225–6, 293 platelet disorders 198, 261, 291
oesophageal varices 83–4, 240 polycythaemia 261
oesophagus 76–7, 238–9, 280, 295 Principles of Assessment 9, 217
oesophagostomy 72, 82, 242 prostate 165, 169, 253, 289
olfaction, loss of 69, 237 Psychiatric Conditions 49–53, 233–4, 279, 294
orbit, disfigurement of 63, 232 psychoses 53, 233–4
osteoporosis 143, 229
otalgia 237
otorrhoea 237
R
ovaries 172–3, 254 range of movement 249
ovulation 254 - upper extremity 244
- lower extremity 245
P reasoning, and neurological function 180, 259, 260, 299

recreation, and loss of amenities 14, 200, 203, 204, 206,
Paget’s disease 229 222, 268, 269, 271, 272, 300
pain 201, 206, 267, 271, 272, 300 rectum 78–80, 238–9, 281, 295
defined 14, 201 relationships, social, and loss of amenities 14, 200, 203, 204,
pancreas 40–2, 76–7, 238–9, 278, 280, 295 206, 222, 268, 269, 271, 272, 300
paralysis renal function 40, 161, 250
- facial 188, 232 Reproductive System 164–73, 252–3, 297–8
- neurological function 186, 256 Respiratory System 28–36, 192, 227–8, 290
parathyroid adenoma 229 rheumatic heart disease 18, 19, 223
peripheral vascular disease 25–6, 38, 224, 276, 277, 292 rhinorrhoea 237
peritoneal dialysis 250
permanent impairment
311
S T
scars, facial, cutaneous 47, 188, 232 taste, loss of 69, 188, 237, 256
scrotum 165, 166–7, 252, 253 see also cranial nerves
seminal abnormality 168–9, 252, 253, 289 tension headache 13, 261
seminal vesicles 169, 252, 253, 289 testis 168, 252
sensory loss, and cranial nerves 186 thrombosis, deep venous 199, 225, 226, 293
sexual function, male 165, 166, 252, 253 thyroid disease 38, 229
skin disorders 44–5, 166, 230–2, 278 tic douloureux 256
shoulder 90, 110, 127–32, 133, 244, 247, 285, 286 tinnitus 68, 237
small intestine 76–7, 238–9, 280, 295 toes 91, 92, 93–4, 101, 220, 245, 246, 283, 284
sneezing 237 see also Principles of Assessment
spermatic cord disease 168, 252, 253, 289 tracheostomy 70, 237
spine 148–58, 269, 301, 302 transitional cases
but note - for lesions of sacrum or coccyx see limb function see Principles of Assessment
tables
social relationships, and loss of amenities 14, 200, 203, 204,
206, 222, 268, 269, 271, 272, 300
U
stoma ulceration 27, 225–6, 293
- miscellaneous ear, nose and throat 237 upper extremity 26, 110–47, 154, 244, 277, 285, 287, 288,
surgically created 70, 82 301
stomach 76–7, 238–9, 280, 295 upper urinary tract 160–1, 250
suffering 10, 202, 206, 218, 222, 267, 268, 271, 272, 291, Urinary System 159–63, 192, 305
300 - lower 162–3, 251
defined 14, 202 - upper 160–1, 250
swallowing impairment 72, 186, 188, 190, 256 uterus 171–2, 254
symptomatic activity levels, assessments of 18, 19, 23, 223–4
312
V
vagina 170
vaginal delivery 170, 254
vascular disease, peripheral 25–6, 38, 88, 224, 276–7, 292
varices, oesophageal 83, 84, 240
varicose veins 225, 293
veins, varicose 225, 293
ventilatory function 227, 293
ventral hernia 242
verbal expression, and neurological function 257, 258, 304
visual acuity, disorders of 63, 235, 294
visual field defects 235
Visual System 13, 38, 54–66, 229, 235, 279, 280
vulva 170, 254, 302
W
whole person impairment
defined 14, 222
written expression, and neurological function 183, 257, 258
wrist 90, 110, 121–3, 133, 244, 247, 285, 286
313
314
315
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Guide To The Assessment of The Degree of Permanent Impairment The Guide Edition 2.1 of The Guide PDF, 1.84 MB

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Guide To The Assessment of The Degree of Permanent Impairment The Guide Edition 2.1 of The Guide PDF, 1.84 MB

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GUIDE TO THE

Comcare gratefully acknowledges the valuable contribution to

This document is the new Guide to the Assessment of the Degree

DIVISION 1—Division 1 is used to assess the degree of an

The Principles of Assessment and Glossary in Part 1 of this

Whole person impairment is assessed under Division 1 of Parts

For injuries suffered by employees after 1 October 2001,

When a final determination of the degree of permanent

Where a final assessment of the degree of permanent

For injuries suffered by employees after 1 October 2001,

See section 3 (Application of this guide) as to assessments of

CLAIMS FOR PERMANENT

LIST OF TABLES AND FIGURES 4

Chapter 2—the respiratory system 28

Chapter 3—the endocrine system 37

Chapter 4—disfigurement and skin disorders 43

Chapter 5—psychiatric conditions 49

Chapter 6—the visual system 54

Chapter 7—ear, nose and throat disorders 67

Chapter 8—the digestive system 73

Chapter 9—the musculoskeletal system 87

Chapter 10—the urinary system 159

Chapter 11—the reproductive system 164

Chapter 12—the neurological system 174

Chapter 13—the haematopoietic system 194

CHAPTER 1—THE CARDIOVASCULAR SYSTEM CHAPTER 3—THE ENDOCRINE SYSTEM

Table 9.9.1a: Wrist flexion/extension 122 CHAPTER 10—THE URINARY SYSTEM

American Medical Association, 2001, Guides to the Evaluation of

American Thoracic Society Ad Hoc Committee on Impairment/

American Thoracic Society, 1993, ‘Guidelines for the evaluation

Cummings J, Mega M, Gary K, Rosenberg-Thompson S, Carusi

Ensalada LH, ‘Complex regional pain syndrome’, in Brigham

1. IMPAIRMENT AND NON-ECONOMIC LOSS 10

Assessments should be made of the impairment suffered in each

Division 1 assembles into groups, according to body system,

ASSESSMENT OF THE DEGREE

Figure 1-A: Activities of daily living

1.1 CORONARY ARTERY DISEASE

Steps for assessment are as follows.

Age and Symptomatic level of activity in METS

Tx means heart transplant.

Note to Table 1.2.1

1. Drug therapy (continuous)—final column of Table 1.2.1:

Note to Table 1.2.2

‘cath’ means either catheter ablation or catheter-

‘PPM’ means permanent pacemaker

‘Device’ means implanted defibrillator.

Table 1.4: Peripheral vascular disease of the lower extremities

% WPI Signs and symptoms

Table 1.5 Peripheral vascular disease of the upper extremities

% WPI Symptoms Signs

Functional Class Symptoms Neither ulceration nor

Surgery includes sympathectomy and local debridement.

Drug(s) means continuous therapy with one or more

In conducting an assessment, the assessor must have regard

Measurements must be performed in a manner consistent with

10 85 to 76 For hyper-reactivity of airways due to occupational exposures,

An impairment rating scale is set out in Figure 2-A (see page

See notes immediately following Figure 2-A.

FEV1, % P FEV1, % change PD20 % of Days lowest FEV1*

Notes to Figure 2-A

2. %P = percent predicted normal value.

Figure 2-B: Calculating obstructive sleep apnoea score